Forms & Documents
Application Forms
Application Instructions
Application
Signed Release Forms need to be returned with your application: English – Spanish (sign both front and back).
Intake/Registration Sites
What We Cover – English
What We Cover – Spanish
Member Forms
Once you are enrolled in Access to Care, you will receive “Your Guide to Access to Care” as well as information about pharmacy programs and services covered. Be sure to read the forms thoroughly.
Your Guide – English
Your Guide – Spanish
Medication Guide – English (July 2020)
Medication Guide – Spanish (July 2020)
Services Not Included – English
Services Not Included – Spanish
Lab Test Locations
X-ray Test Locations
ATC Flyer ‘What We Cover’ in additional languages:
Arabic
Farsi
Korean
Mandarin
Polish
Russian
Urdu