California PHC
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- Provider Information Updates
- Provider Newsletters
- Provider Notices
- Enhanced Care Management & Community Supports
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- Provider Grievances
- Skilled Nursing Facility (SNF) Workforce Quality Incentive Program (WQIP)
- Southern California Fires and Flexibilities of Impacted Providers
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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 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)
- Demographic Detail Form
- Notice of Privacy Practices
- Provider Directory (effective May 1, 2025)
You can search for providers and facilities online. Go to the Network Provider and Facility Search page.
| To report any errors in the PHC California Provider Directory, please send an email to [email protected]. You may also report directory errors by calling Member Services at (800) 263-0067, Option 1 (TTY 711). Agents are available Monday through Friday, 8:00 am to 8:00 pm. |
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.
DHCS 030716 PHC FR Form 1.0
Page Updated: May 30, 2025 @ 7:15pm