MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Additional Member Forms | Allwell from Superior HealthPlan
Additional Forms
- PHI Authorization Forms - Use this form when you want to allow Allwell to share your health information with a person or group.
- PHI Revocation Forms - Use this form when you want Allwell to cancel or revoke your previous permission to share health information with a person or group.
Material ID: Y0020_SHP_20228996_C Internally Approved 06/29/2022
Use this form to name a person to act as your representative. Must be completed by you and accepted by the person you appoint.
If you have questions please, contact Member Services.