Provider Forms

For assistance with finding or submitting completed forms, contact Provider Services at 650-616-2106 or

NEW PRIOR AUTHORIZATION REQUEST FORM: HPSM has revised the Prior Authorization Request Form and will no longer accept submissions of the old form starting February 1, 2020. Please alert your staff of this revised form and timeline. If you have any questions about this update please contact the HPSM Provider Services Department.

Authorization Forms

Please do not use the Prior Authorization Request Form for Pharmacy Drug Requests.

Claims & Billing Forms

Clinical/Health Assessment Forms

Staying Healthy Assessment Tools

Dispute Resolution Forms

Assignment & Un-assignment Forms

Quality Improvement Forms

Forms for Non-English Speaking Patients