Forms and other important documents
Covered services lists
Provider and pharmacy directory
Personal representative forms
- Personal Representative Authorization Form – Disclosing Personal Information
This form gives us permission to share your personal information to another person.
- Personal Representative Authorization Form – Filing an Appeal
This form gives permission to someone else to file an appeal for you.
- Veteran’s Office Authorization for Release of Personal Information form
This form gives us permission to share your personal information with a veteran’s office.
- Request for an Accounting of Disclosures of Personal Information form
Use this form to ask us for a list of people we have shared your information with for reasons other than treatment, payment or health care operations.
- Restriction form
This form puts limits on how we use or share your personal information.