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Request for Extension of Mental Health Services

When requesting an extension of mental health services, providers should complete the Request for Extension Form and submit along with supporting clinical information. Attach this completed form to your online request or fax it along with the Inpatient TRICARE Service Request/Notification form to 1-844-818-9289.

  • Created: Oct 19, 2016
  • Modified: Dec 5, 2018
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