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Home > Members > Member Forms

Member Forms, Filings, and Change Requests

Find the forms you need to get the most out of your health plan.

Do you have questions or need help with a form? Call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.

  • Ohio PCP change form (PDF)
  • Change of address (County)
  • File a grievance or appeal
  • Authorized representative (PDF)
  • Advanced Directive (PDF)
  • HIPAA form (PDF)
Members
  • Find a doctor, medicine, or pharmacy
  • Benefits
  • How to enroll
  • Next steps for new members
  • Getting care
  • Important phone numbers
  • Pregnancy
  • OhioRISE
  • Member handbook
  • CARE Card rewards
  • Forms
  • Newsletter and updates
  • Member portal
  • Mobile app
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