Publications and Forms
These publications and forms are for plan members. If you need a publication or form that isn’t here, contact Member Services. If you want a printed copy of any of the items here, contact Member Services.
DHCS 030716 PHC Form 1.0
- Member Handbook (Combined Evidence of Coverage (EOC) and Disclosure Form) (effective January 1, 2020)
- Comprehensive Formulary (effective January 1, 2020)
- Health and Wellness Benefit Election Form
- Over-the-Counter (OTC) Formulary and Order Form (effective April 13, 2020)
- Authorization for Use or Disclosure of Health Information
- Complaint and Grievance Form
- Notice of Privacy Practices
- Provider and Pharmacy Directory (effective September 1, 2020) You can search for providers, facilities and pharmacies online. Go to the Network Provider, Facility and Pharmacy Search page.
To report any errors in the PHC California Provider and Pharmacy, please send an email to california.directory.errors@positivehealthcare.org, or send a message using our web form. You may also report directory errors by calling Member Services at (800) 263-0067, Option 1 (TTY 711). Agents are available Monday through Friday, 8:00 am to 8:00 pm. |
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.
DHCS 030716 PHC Form 1.0