Frequently Requested Forms

Medical Record Access, Changes,
and Health Care Information Release

Instructions: How to Transfer and Get Copies of Your Medical Records

Parental Access

Instructions: Request Access to Your Child's Online Record
From birth through age 17; access changes at child's 13th birthday

Enrollment and Change Forms

Pharmacy and Medical Reimbursement

Instructions and forms: How to Submit Claims for Reimbursement
For both Medicare and non-Medicare claims. Also foreign claims.

Pharmacy Forms

Claim Forms

Specialty Visit Questionnaires

You may be asked to fill out a questionnaire before an appointment with a specialist.

Well-Care Questionnaires

These questionnaires are to be filled out before a well-care visit, also called preventive care.

Informed Consent Forms

Advance Directive Forms

Instructions: Advance Directives and End-of-Life Decisions

* To protect the security of personal information, you must sign on to the member website to use these online forms. This helps us process your request more quickly. (To sign on, you have to be registered.)

If you don't want to sign on, in some cases, there is also a PDF version of the same form. However, you must print the PDF, fill it out, and send it via postal mail. For security reasons, PDFs cannot be submitted as e-mail attachments.

** You can refill and transfer prescriptions online by signing on to the member website. (To sign on, you have to be registered.)