General Forms and Resources

At Prominence Health Plan, our goal is to make our health plans easy to understand and our coverage easy to access. We are committed to helping our members get what they need from their health plan by providing all our tools and resources in an efficient and convenient manner. Below are links to a variety of downloadable forms and resources:

Authorization for Disclosure of Protected Health Information Forms

Pharmacy Forms

Continuity of Care Form

Provider Procedure CPT Codes

Prior Authorization (PA) Requirement Lists

Prior Authorization (PA) Request Forms (for Providers)

Advance Directives, Healthcare Decision-Making

Other Forms

Sample Member ID Cards