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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)
Nevada Claim Form (PDF)
Member PHI Release Authorization Form (PDF)
Coordination of Benefits Form (PDF)
Applied Behavioral Analysis (ABA) Authorization Form (PDF)
ACA Individual Plan Member Change 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)
If you don't find the form you’re looking for, contact your Group Services representative.