Authorization Request for
Additional Outpatient Mental Health Service
Click here to open and print or save the Authorization Request for Additional Outpatient Mental Health Service form.
This request is to only be used for ADDITIONAL OUTPATIENT SERVICES for a client. Requests for new outpatient services should be directed to TEAM using the "Authorization Request for New Outpatient Services" at www.team-mn.com.
Please print clearly. Incomplete or illegible forms can not be processed.
Please fax completed forms to TEAM at: 651-642-1809
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