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Member materials
Medallion (Medicaid)/FAMIS Member handbook ― English (PDF) | Spanish (PDF)
CCC Plus Member handbook ― English (PDF) | Spanish (PDF)
Diabetes wellness exam flyer ― English (PDF) | Spanish (PDF)
Transitioning from Pediatrics to Primary Care Flyer ― English (PDF) | Spanish (PDF)
Well Woman Exams Flyer ― English (PDF) | Spanish (PDF)
Men's Health Exams Flyer ― English (PDF) | Spanish (PDF)
EPSDT Member Tip Sheet: Birth to 3 years ― English (PDF) | Spanish (PDF)
EPSDT Member Tip Sheet: Ages 3 to 21 years ― English (PDF) | Spanish (PDF)
Men and women's health brochure ― English (PDF) | Spanish (PDF)
Mental health resources for BIPOC youths (PDF)
Mental health resources for teens in the LGBTQ community (PDF)
Forms
Protected health information (PHI) release form ― English (PDF) | Spanish (PDF)
Nursing facility transition brochure (PDF)
Maternity Incentive Program form ― English (PDF) | Spanish (PDF)
Important information regarding PPL (Public Partnerships, LLC) (PDF)
Member reimbursement request form for Native medicine (PDF)
Protected health information (PHI) access request form ― English (PDF) | Spanish (PDF)
Authorization to release psychotherapy notes ― English (PDF) | Spanish (PDF)
Request for an Accounting of Disclosures of Protected Health Information (PHI) ― English (PDF) | Spanish (PDF)
Removal of Authorization Previously Given to Aetna ― English (PDF) | Spanish (PDF)
Ted E. Bear, M.D., Wellness Club enrollment and incentive form ― English (PDF) | Spanish (PDF)