Gender Reassignment Surgery Authorization Form Mobile App
Prior to Gender Reassignment use the Gender Reassignment Surgery Authorization Form mobile app to complete surgery authorization.
How does it work?
The app details requirements for requirements for mastectomy (female-to-male patients), requirements for gonadectomy (hysterectomy and oophorectomy in female-to-male and orchiectomy in male-to-female), requirements for genital reconstructive surgery (i.e., vaginectomy, urethroplasty, metoidioplasty, phalloplasty, scrotoplasty, and placement of a testicular prosthesis and erectile prosthesis in female-to-male; penectomy, vaginoplasty, labiaplasty, and clitoroplasty in male-to-female), characteristics of a qualified mental health professional, format for referral letters from qualified health professional and dsm 5 criteria for gender dysphoria in adults and adolescents. The app should be completed by the clinician who has a thorough knowledge of the member’s current clinical presentation and his/her treatment history. Please complete all parts as clearly and specifically as possible. Omissions, generalities and illegibility will result in the form being returned for completion or clarification.