Find a Form
Appoint a Representative
You have the right to appoint someone to represent you in medical matters (such as a family member, friend or other trusted person). A representative can contact HPSM on your behalf, get information about your benefits and make decisions about your medical care. If someone contacts HPSM claiming to be your representative, we will check our records to confirm their status before sharing your health information or taking any action.
Address Change Form
To change your address or phone number, fill out the form below and return it to HPSM.
CareAdvantage Enrollment Form
To join CareAdvantage CMC please complete and return the enrollment form. Eligible members must have Medicare Part A, Medicare Part B, and Medi-Cal through the Health Plan of San Mateo. If you are not a native English speaker, you can call 1-888-252-3153 to get the form in a different language.
Durable Power of Attorney
The Advance Health Care Directive gives someone you chose the power to make decisions about your medical care in the event that you become too sick to make them yourself. HPSM recommends that everyone appoint durable power of attorney to someone they trust. To do that, fill out Part 1 of the Advanced Health Care Directive, have it notarized and follow the instructions on the last page.
Health Records Request Form
Fill-out and return the Protected Health Information Request Form to authorize the release of your health information.
Member Complaint Form
Use this confidential form to submit a written complaint to HPSM. This form is optional. You may also file a complaint by calling us or visiting our office to speak face-to-face with a representative.
Provider Search Form
Find a provider
- Search by provider name, health plan, location or type of provider
- Click on a provider's name in the search results to see additional information
- Search results include links to interactive maps and directions
- Print or save the information for individual providers
- Weekly updates ensure you get the most accurate results
Choose a New PCP
No matter how long you’ve been an HPSM member, you can choose a new PCP. You can have the same PCP for all your family members or a different PCP for each person (e.g., children).
Call us for assistance
Call 1-866-880-0606 or 650-616-2174 Monday–Sunday 8:00 a.m. to 8:00 p.m.
Members of all other plans:
Call 1-800-750-4776 or 650-616-2133 Monday–Friday 8:00 a.m. to 6:00 p.m.
TTY: 1-800-735-2929 or dial 7-1-1