Download and print a health care form:
- Allowables Request
- APRN/PA Competency Form (PDF)
- Authorization for the Release of Protected Health Information (PDF)
- AZ Prior Authorization Request Form (PDF)
- Behavioral Health Injectable Antipsychotic Prior Authorization Form (Genoa Pharmacy) (DOC)
- Claims Reconsideration Form (PDF)
- Hospital Based Provider Enrollment Form (PDF)
- HPN and SHL Provider Demographic Update Form (PDF)
- Initial Credentialing Form (PDF)
- Medical Necessity Request Form (PDF)
- New Prescription Fax Order Form (PDF)
- New Prescription Mail-in Order Form (PDF)
- Nevada Claim Form (PDF)
- Step Therapy Exception Prior Authorization Form (DOC)
- Behavioral Health Outpatient Treatment Request Form (PDF)
- Pharmacy Reimbursement Claim Form (PDF)
- Primary Care Physician Change Form (PDF)
- Prior Authorization Form (PDF)
- Recredentialing Form (PDF)
- QOC Internal Referral Form (PDF)
- Substance Abuse Records Release Form
- Transition of Care and Continuity of Care Form (PDF)
- Transplant Referral Fillable Form (PDF)
- General Guidelines For Bone Marrow Transplant/Stem Cell Transplant Referrals (PDF)
- General Guidelines For Heart Transplant Referrals (PDF)
- General Guidelines for Kidney Transplant Referrals (PDF)
- General Guidelines For Liver Transplant Referrals (PDF)
- General Guidelines For Lung Transplant Referrals (PDF)
If you don't find the form you’re looking for, contact Provider Services.
