Member materials and forms

Member materials 

Integrative health services member handbook ― English (PDF) | Spanish (PDF)

Mental health and substance use treatment services handbook ― English (PDF) | Spanish (PDF)

Provider and pharmacy directory (PDF)

Clinical Practice Guidelines (PDF)

Forms

Submit a Grievance (PDF)

Member Appeal Form (PDF)

Authorization to release protected health information (PHI) (PDF)

Authorization to release psychotherapy notes (PDF)

Fraud, waste and abuse form

Grievance and appeal form

Member advisory committee application ― English (PDF) | Spanish (PDF)

Notification of pregnancy (PDF)

Transition of care form ― English (PDF) | Spanish (PDF)

Notice of Privacy Practices  ― English (PDF) | Spanish (PDF)