Provider Forms

For assistance with finding or submitting completed forms, contact Provider Services at 650-616-2106 or psinquiries@hpsm.org.

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

Authorization Forms

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