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Member Forms & Notices

Documents, forms and notices for Providence Health Plan members. You may be able to fill some of these forms on your computer, then print, sign (if necessary) and submit via instructions on the form.

Member Forms

Consent Form

Transition of Care

Claims

Most providers bill Providence Health Plan directly, however if you must submit a medical claim to Providence, please use this form:

Pharmacy

Designated Record Set

Member Notices

TruVision

Discounts on eye examinations, laser vision correction, and more.