Member Handbooks and Forms
- Appeal Request Form (PDF)
- Advance Directive Form and Instructions (PDF)
- Member Prescription Drug Reimbursement Request (DMR)(PDF)
- Prescription Drug Mail Order Form (PDF)
- Request to Change Lock-In Pharmacy and/or Provider (PDF)
- Authorization to Disclose Protected Health Information-English (PDF)
- Authorization to Disclose Protected Health Information-Spanish (PDF)
- Revocation of Authorization to Disclose Protected Health Information-English (PDF)
- Revocation of Authorization to Disclose Protected Health Information-Spanish (PDF)
- Request to Access (See) Records-English (PDF)
- Request to Access (See) Records-Spanish (PDF)