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NC Medicaid »   Providers »   Forms »   Hearing Loss and Auditory Processing Forms

Hearing Loss and Auditory Processing Forms

Hearing Aid Post Dispensing Evaluation Form

Note:  The following forms can be found on the NCTracks Prior Approval Web Page

  • Hearing Aid Services Request for Prior Approval (DMA-0001)
  • Auditory Implant Sound Processors Request (DMA-0003)

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https://medicaid.ncdhhs.gov/providers/forms/hearing-loss-and-auditory-processing-forms