Currently Approved Version of i3441 eAuthorization Screens

i3441 screenshots
About the Request for Reconsideration page (Updated screen)

YES path
Review and send: Medical Release Form page (New screen)

YES path
Review and send: additional forms we need page (New screen for eAuthorization users)
Need to discuss the flow using ‘Print Cover Sheet’ button because this format differs from the current
functionality of the application.

YES path
Review and send: print cover sheet page (Updated screen for all users)

YES path
Confirmation page (New screen for eAuthorization users)

NO then YES path
Review and send: Medical Release Form page

NO then YES path
Please confirm page (New screen)

NO then YES path – Radio button for I agree is pre-selected.
Review and send: Medical Release Form page

Then follows YES path described above.

No Path will continue to have the existing screen flow.

Medical Release Form – opens in new window