Capital Diabetes & Endocrine Associates
301-899-7713
301-899-9430
5801 Allentown Rd Ste 500, Camp Springs, MD 20746
2101 Medical Park Dr. Suite 211 Silver Spring, MD 20902

Forms and Prior Authorizations

FORMS:

Office Policy (For you to keep)

Authorization for Release of Medical Records

HIPPA Form

New Patient Medical History Form

New Patient Medical History Form (Spanish)

New Patient Registration Form

New Patient Registration Form (Spanish)

Glucose Logs

Insulin Sliding Scale

Capital Health and Metabolic Forms

Our Approach to Prior Authorizations

At CDEA, we work hard to ensure you get the medications you need without unnecessary delays. Over the past few years, prior authorizations (PAs) have increased significantly — and many have become more complex. Some are quick and can be completed electronically, while others require in-depth documentation from your provider.

Types of PAs

1. Quick & Simple PAs (No Appointment Needed)

  • Can be submitted electronically.
  • Usually require only basic information.
  • Our team handles these right away.

2. Complex PAs (Appointment Required)

  • Require specific forms documenting treatment trials, medication failures, or contraindications.
  • The most common medicines that require these kind of PAs are weight loss medicines.
  • Must be completed by your provider after a thorough review of your medical records.
  • Starting September 1, 2025:
    • Patients must schedule an appointment for providers to complete these forms.
    • Appointments may be in-person, online, or by phone.

Patient-Initiated PAs

Some insurance plans allow patients to start and submit their own PA requests. This can sometimes speed up the process. If you choose this option:

Step 1: Learn Your Insurance Plan’s Process

  • Call your insurance company or log into their member portal.
  • Ask if they allow patient-initiated PAs.
  • Download or request any required forms.

Step 2: Gather Required Information

  • Medication details: name, dosage, prescribing provider.
  • Diagnosis & history: reason for the medication, treatments already tried.
  • Provider information: your CDEA provider’s name, practice name, phone, fax, and NPI (if required).

Step 3: Submit Your PA

  • Follow your insurance company’s submission instructions (online, fax, or mail).
  • Notify your CDEA provider so we can respond to any requests from your insurer.

Step 4: Follow Up

  • Track the status through your insurer’s portal or by phone.
  • If denied, contact your provider to discuss additional documentation or resubmission.

💡 Tip: Some specialty pharmacies handle PAs directly, for example: ASPN for Afrezza, US Med for CeQur Simplicity, Sterling for Tirosint.