Mental Health

Personal Growth
Counseling and Therapy
Addiction and Recovery
Care Provider Directories
Videos, Audio, and CD-ROM
Forms
Request for Access to Protected Health Information
Member Grievance Form
Request to Restrict Use and/or Disclosure of Protected Health Information
Member Grievance Form
California Member Grievance Form
Confidential Exchange of Information Form
California Grievance Form for Members
Authorization for Release of Health Information
Authorization for Release of Health Information
Request for Confidential Communication
New York State Health Insurance Claim Form
Request for Accounting of Non-Routine Disclosures of PHI
Request to Revoke or Change Prior Confidential Communication Request
Health Insurance Claim Form
California Health Plan Grievance Form
California Member Grievance Form