TX HHS Form 5203. Breast MRI Pre-Authorization Request

The TX HHS Form 5203, Breast MRI Pre-Authorization Request, is a crucial document for healthcare professionals to complete before performing breast magnetic resonance imaging (MRI) procedures. This form helps ensure that patients receive the necessary authorization for their treatment while also streamlining the process for healthcare providers.

This pre-authorization request form requires essential information from healthcare providers, including client details, medical history, and procedure specifics. Key features of this form include a section on patient history and physical information, which asks about relevant conditions such as breast cancer risk factors, family syndromes, and previous treatments. Additionally, the form inquires about recent screening or diagnostic procedures received through BCCS or before being referred to BCCS for an MRI procedure.

Healthcare providers typically fill out this form to request pre-authorization for breast MRI procedures. By completing this form, healthcare professionals can ensure that patients receive the necessary authorization and follow-up actions are taken accordingly. Key points to note include:

• The form is used for breast MRI pre-authorization requests.
• Healthcare providers must complete the form before performing breast MRI procedures.
• The form requires essential information from healthcare providers, including client details and medical history.