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Forms
Authorization release for grievance/appeal form (PDF)
CVS mail order form ― English (PDF) | Spanish (PDF)
State fair hearing request form (PDF)
Authorization form to release protected health information ― English (PDF) | Spanish (PDF)
Authorization form to release psychotherapy notes ― English (PDF) | Spanish (PDF)
Protected health information access request form ― English (PDF) | Spanish (PDF)
Request form for an accounting of disclosures of protected health information ― English (PDF) | Spanish (PDF)
Request form to remove authorization previously given to Aetna Better Health ― English (PDF) | Spanish (PDF)