PHC California

Rachel Sakai
AHF Provider

Publications and Forms

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 January 1, 2020)
  • Supplemental Notice – Provisional Postpartum Care Extension Program
• Comprehensive Formulary (effective January 1, 2020)
• Health and Wellness Benefit Election Form
• Over-the-Counter (OTC) Formulary and Order Form (effective April 13, 2020)
• Authorization for Use or Disclosure of Health Information
• Complaint and Grievance Form
• Notice of Privacy Practices

• Provider and Pharmacy Directory (effective January 1, 2021)
  You can search for providers, facilities and pharmacies online.  Go to the Network Provider, Facility and Pharmacy Search page.

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.