California PHC

These publications and forms are for plan members. If you need a publication or form that isn’t here, contact Member Services. If you want a printed copy of any of the items here, contact Member Services.

• Member Handbook (Combined Evidence of Coverage (EOC) and Disclosure Form) (effective 2026)
• Member Handbook (Combined Evidence of Coverage (EOC) and Disclosure Form) (effective 2025)
• Health and Wellness Benefit Election Form
• Over-the-Counter (OTC) Formulary and Order Form (effective May 20, 2025)
• Authorization for Use or Disclosure of Health Information
• Complaint and Grievance Form (Formulario de quejas y reclamaciones)
• Notice of Privacy Practices
  PHC California protects your personal health information whether it is in oral, written and electronic form.
• Demographic Detail Form
  Acceptable and Not Acceptable Use of Data
  Demographic data gathered through the Member Demographic Detail Form is used to help quality improvement activities. It is also used to find and fix health disparities (gaps.) Lastly, it is used to help meet regulatory and accreditation requirements.
  This data may not be used for marketing or solicitation. It may not be used in any way that could cause you to be discriminated or stigmatized. This data will only be used for the purpose of improving care delivery and health equity.
• Provider Directory (effective November 1, 2025)
  You can search for providers and facilities online. Go to the Network Provider and Facility Search page.  If you need help finding a provider or facility (or more information such as race/ethnicity), please call please call Member Services at (800) 263-0067.

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.