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Behavioral Health

PW_E180868

Behavioral Health

Outpatient Treatment Report - TMS 

Outpatient Treatment Report 

Individual Authorization Form 

Provider Maintenance Form 

Provider Specialty Profile 

Psychological Testing Authorization Form 

Psychotherapy Notes Authorization Form 

 
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Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.