San Francisco Health Plan: Providers: Provider Resources: Download Forms

Providers: Provider Resources: Download Forms

Download Forms

Choose a form:

Authorizations
Facility Site Reviews
Grievances
Staying Healthy
Provider Claim Dispute

Authorizations

CHN Prior Authorization Request Form

Pharmacy Prior Authorization Request Form

Fax completed pharmacy prior authorzation request forms to National Medical Health Card Rx at 1 (800) 945-1815 or submit them online at www.nmhcrx.com