Behavioral/Physical Health Coordination Form (PDF)
It’s important for both your behavioral and physical healthcare providers to know what kind of care you are getting. Keep your doctors connected by taking the Behavioral/Physical Health Coordination form to your next visit.
Get Access to your Personal Health Information
Authorization of the Use and Disclosure of Protected Health Information (PDF)
Completing this form will allow MHS to share your personal health information with another company or individual that you name.
Revocation of Authorization to Use and/or Disclose Health Information (PDF)
Completing this form will allow you to revoke your approval of MHS sharing your personal health information with another company or individual that you previously named.
Choose a Representative to Appeal
Authorization for Another Person to Appeal in your Name (PDF)
Completing this form will allow a person that you choose represent you in an appeal for services from MHS.
Contact the State to Report a Change (Address, Phone Number, etc.)
Call the Department of Family Resources (DFR) at 1-800-403-0864 or go to the FSSA Benefits Portal
If you would like this information in print, please contact MHS Member Services.