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Health Care Forms
Download and print a health care form.
Authorization for the Release of Protected Health Information (PDF)
Employee Enrollment and Change Form (PDF)
Employee Enrollment and Change Form - Spanish (PDF)
Employer Group Enrollment Form (PDF)
2021 Individual Off Exchange Application Form (PDF)
2021 Individual Off Exchange Member Change Form (PDF)
2022 Individual Off Exchange Application Form (PDF)
2022 Individual Off Exchange Member Change Form (PDF)
Coordination of Benefits Form (PDF)
Applied Behavioral Analysis (ABA) Authorization Form (PDF)
Nevada Claim Form (PDF)
Primary Care Physician Change Form (PDF)
Pharmacy Reimbursement Claim Form (PDF)
Substance Abuse Records Release Form (PDF)
New Prescription Mail-In Order Form (PDF)
New Prescription Fax Order Form (PDF)
Medical Necessity Request Form (PDF)
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