Forms
- Authorization Form for Appeals/Grievances
- CVS Mail Order form (English|Spanish)
- State Fair Hearing Request Form
- Authorization to Release Protected Health Information
- Authorization to Release Psychotherapy Notes
- Protected Health Information Access Request
- Request for an Accounting of Disclosures of Protected Health Information
- Removal of Authorization Previously Given to Aetna Better Health
- Authorization to Release PHI (Spanish)
- Authorization to Release Psychotherapy Notes (Spanish)
- PHI Access Request Form (Spanish)
- Request for an Accounting of Disclosures of PHI (Spanish)
- Removal of Authorization Previously Given to Aetna (Spanish)