|Classification / Identification:|
| ||Form Number:||5041-77E||Edition date: ||2020/02 |
| ||Title:||Request for Prior Approval for Funding of Sex-Reassignment Surgery|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Health Service Branch|| || |
| ||Program:||Policy and Projects Team|| || |
| ||Purpose of Form:||Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.|| || |
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