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