Prior Authorization - Gold Card Efforts

Please fill out this form if you are interested in helping OSMA with the prior authorization “gold card” effort!

If you have questions, email kstone@osma.org.
Contact information:
First Name
Last Name
Designation (MD, MPH, PhD, etc.)
Organization
Email
Mobile Phone
Interested in: select any/all that apply
Testifying
Meetings
Resource for OSMA team
Any of the above
Additional comments:
   - denotes required fields