Member Handbooks and Forms
Member Handbook/EOC
- California Health & Wellness Member Handbook (PDF)
- Changes to Non-Emergency Medical Trasportation (NEMT) (PDF)
- California Health & Wellness Medi-Cal Postpartum Care Extension Program (PPCE Errata) (PDF)
Forms
- Member Claim Form (PDF)
- Authorization to Disclose Protected Health Information Form (PDF)
- Revocation to Disclose Protected Health Information Form (PDF)
- California Children’s Services (CCS) Application (PDF)
- Continuity of Care Request Form (PDF)
- Grievance Form
- Health Information Form (PDF)
- Notification of Pregnancy Form (PDF)
- Primary Care Physician (PCP) Change Form (PDF)
- Advance Health Care Directive Form (PDF)
- POLST Form
- Care Management Referral Form (PDF)