Another group or vendor provides the info on the next page. If you don’t want to leave our site, choose the “X” in the upper right corner to close this message. Or choose “Go on to next website” to move forward.
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)
Caregiver resources