Integrated Care Collaboration Improving Access to Healthcare in Central TexasIntegrated Care Collaboration
Improving Access to Healthcare in Central Texas

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ICC Forms

 

ICC Authorization Form (English)

ICC Authorization Revocation (English)

ICC Authorization Q&A (English)

 

ICC Authorization Form (Spanish)

ICC Authorization Revocation (Spanish)

ICC Authorization Q&A (Spanish)

 

Suggested Process for Obtaining Authorizations

ICare New System User Request Form (ICC Confidentiality Agreement)

 

 

 

ICC of Central Texas
8627 N. Mopac Expwy., Suite 140   Austin, TX 78759
Phone: (512) 804-2090     Fax: (512) 804-2096
Contact Us