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Member handbooks
Forms
- Authorization to release protected health information (PHI) — English (PDF)
- Authorization to release protected health information (PHI) — Spanish (PDF)
- Authorization to release psychotherapy notes — English (PDF)
- Authorization to release psychotherapy notes — Spanish (PDF)
- PHI access request — English (PDF)
- PHI access request — Spanish (PDF)
- Request an accounting of disclosures of PHI — English (PDF)
- Request an accounting of disclosures of PHI — Spanish (PDF)
- Removal of authorization previously given to aetna — English (PDF)
- Removal of authorization previously given to aetna — Spanish (PDF)
- Fraud, waste and abuse form
- Behavior Analysis Change of Member Form — English (PDF)
- Behavior Analysis Change of Member Form — Spanish (PDF)