When your DeltaCare® USA patients need referral for emergency treatment, you can easily download the emergency preauthorization form online.

What is the emergency preauthorization form?

The emergency preauthorization form allows you as a primary care DeltaCare USA dentist to refer your patients to a specialist for emergency treatment.

The form captures the issues you’ve diagnosed as well as your recommendations for treatment. It also informs specialists that such treatments may not normally be covered under the patient’s DeltaCare USA plan.

How to find the emergency preauthorization form

To download the form from our website, visit the Administrative and claim forms page. The form is listed under Dentist Administrative Forms and Resources.