Member Handbooks and Forms
Member Handbooks
Your Member Handbook explains services that are available to eligible children/young adults and their families. If you would like a printed copy of this handbook, please call us at 1-855-202-0973 (TTY 711).
Forms
You will need to download and install Adobe Acrobat Reader from this site to use the pdf forms.
- Authorization for Use and Disclosure of/Consent to Release Protected Health Information (PHI) -- YOU MUST FILL OUT ALL PARTS OF THIS FORM. IF ANY PART IS LEFT BLANK IT WILL BE RETURNED TO YOU TO FIX.
	- English instructions (pdf)
- English form (pdf)
- Spanish instructions (pdf)
- Spanish form (pdf)
 
- Magellan Complaint (Grievance) Form
	- Online form
- English form (pdf)
- Spanish form (pdf)
 
- Magellan Appeal Form
	- English form (pdf)
- Spanish form (pdf)
 
- Idaho Department of Health and Welfare Appeal/State Fair Hearing Form
	- English form (pdf)
- Spanish form (pdf)
 
- Intensive Care Coordination Referral Form
	- English form (pdf)
- Spanish form (pdf)
 
- Residential Treatment and Psychiatric Residential Treatment Form
Member Request for Access to Protected Health Information
Members have a right to access their Protected Health Information (PHI) maintained by Magellan Health, Inc. 
Please fill out the below form and submit your records request to either of the following: 
- Form: Member Request for Access to Protected Health Information (PHI) (pdf)
- Email: IBHPRecordsRequest@MagellanHealth.com
- Fax: 888-656-2585