Other Requests Attachment #2 2 24 2017 Redacted

1 MB·English

Office of Administration
Commissioner's Office

‘Request for Preauthorization for Uther Scrvices

Program: Alternatives to Abortion
Contractor ave
Shona 6E St josop>.

Pluase enter below the information foreach itam service ta be purchased. Lis the date of porchase
iuea: to be purcased, cast or the iers, and the justification, Memes must de approved before

caetavedfproicedto bereimarsed
cert ome: MMMM ate Ew ote 92/20/47 -
[saree Yotalcast | Jusieaton cada sour
vuretuse Dae ncn format artuning tat have een
ricer
| |

2/28/17 Tdi size tan
‘alesars matress

oy

singe current air matress has hale
‘thar is noe repiratily, Sw is due Ww
liver baby giel on 4/28/17. and
Fras no uals fora ews mareress

sual wot able ro prchase used one,

foclins ability ra haa rates
lupstsies i hecapt complex.

Fina a be
seiutkursed

Please return to Alternatives to Abortion Program Manuger, State of Missouri - Office of
‘Admnistration, Commissioner’ Office, State Capitol Bulldiug, Koom, 125, Jefferson City, MO
(65201. Mry be faved tn 572/751-1212 or winalled to emul kveition.mngov

by the Contractor aniy!

Thank you
i

|
Authorized person requesting purchase:

Anproved for purchase: _

Purvhane dene: bate

Reason for denying parts
esi ro a

Breck era

Read al'90reviews

Questions &Answers queens

cor caer iho on

£39.00 eu 2129.00 om 196.55 '

\, stn SettoctFoam 7 signs er ueseap seman 3¢ cat Sasi

\ pul 4

Policies & Plans

‘ony see plas aptinésad pees tht rn he snipe