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Application for Residential Treatment Center – Provider

This application must be completed in its entirety by the referring provider when residential treatment center (RTC) placement is requested. Attach this completed form along with the Family RTC application to your online request or fax it along with the Inpatient TRICARE Service Request/Notification form to 1-844-818-9289.

  • Created: Aug 1, 2022
  • Modified: Dec 5, 2018
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