Provider Emergent Inpatient Admission Authorization Request Form
This form is for non-contracted providers. Contracted providers should submit authorization requests and check status online by logging in at hap.org and selecting Authorizations.
Please complete all fields below and include supporting clinical information (e.g., presenting clinical, lab results, radiology results, response to treatment, plan of care, etc.).
If you have any questions, call (313) 664-8833 option 3.