Member Forms

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Below is a list of forms that are in Adobe® Portable Document Format (PDF) for your convenience. The PDF (Portable Document Format) will preserve the look and feel of the original document, including the colors, images and formatting. If you do not have the Acrobat Reader—or aren't sure—get the free Acrobat Reader now. If there are any questions please don't hesitate to ask NHP!

POS Claim Form

Authorization for Use and Disclosure of Protected Health Information

Grievance Form

Appointment of Representation

Advance Directives Records Form

Member's Rights & Responsibilities

Pharmacy Reimbursement Claim Form

Member Handbook - Large group

Member Handbook - Small group

Standard HMO Co-Payment Contract

Basic HMO Co-Payment Contract

Standard HMO Deductible Contract

Basic HMO Deductible Contract

October 2008 Amendment

- This modification applies to new groups effective October 1, 2008 or effective the date of renewal of coverage with Neighborhood Health Partnership, Inc. (NHP)"