Member Handbooks and Forms
Member Handbook/EOC
Please note: There are new options for managing your Digital Medical Records.
- California Health & Wellness Member Handbook – English (PDF)
- California Health & Wellness Member Handbook – En Español (Spanish) (PDF)
- California Health & Wellness Member Handbook – Russian (PDF)
- CA Cancer Equity Act Referrals Errata - English (PDF)
- CA Cancer Equity Act Referrals Errata - En Español (Spanish) (PDF)
- CA Cancer Equity Act Referrals Errata - Russian (PDF)
- Street Medicine Programs Errata - English (PDF)
- Street Medicine Programs Errata - En Español (Spanish) (PDF)
- Street Medicine Programs Errata - Russian (PDF)
Forms
- Member Claim Form – English (PDF)
- Authorization to Disclose Protected Health Information Form – English (PDF)
- Revocation to Disclose Protected Health Information Form – English (PDF)
- Confidential Communication Request Form – English (PDF)
- Confidential Communication Request Form – En Español (Spanish) (PDF)
- Confidential Communication Request Form – Russian (PDF)
- Confidential Communication Revocation (Cancellation) Form – English (PDF)
- Confidential Communication Revocation (Cancellation) Form – En Español (Spanish) (PDF)
- Confidential Communication Revocation (Cancellation) Form – Russian (PDF)
- Grievance Form
- Reverse Opioid Overdoses and Help Save Lives with Naloxone – English (PDF)
- Reverse Opioid Overdoses and Help Save Lives with Naloxone – En Español (Spanish) (PDF)