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