Authorization to release psychotherapy notes (PDF)

Protected health information access request (PDF)

Request for an accounting of disclosures of protected health information (PDF)

Removal of authorization previously given to Aetna Better Health^® (PDF)

Grievances and appeals printable form (PDF)

Prescription mail service order form (PDF)

Authorization to release protected health information (PDFs) — English  | Español  | 繁體中文 |
简体中文 | русский | فارسی | Tagalog | Hmoob | Tiếng Việt | Bosanski

Access2Care nonemergent medical and nonmedical transportation parent/guardian authorization — transportation of minor (PDFs) — English |Español | 中文  | русский |عربى | Tagalog | Hmoob |Tiếng Việt