Vermont Official State Website

Forms

Clinical Prior Authorization Forms

Dental Prior Authorization Forms

Pharmacy Prior Authorization Request and Order Forms

Prior Authorization, Tools and Criteria

Ambulance Agency Assessment Reporting Form

Forms Non-Emergency Medical Transportation

Department of Vermont Health Access

280 State Drive
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260

Contact List for staff email, telephone & fax numbers

Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

Public Record Requests
Kelly Provost
DVHA Public Records Officer
AHS.DVHALegal@Vermont.gov
Visit the Agency of Administration site for the Public Records Database

Report Medicaid Fraud, Waste, and Abuse