Member Forms

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Registration & Prescription Order Form
(624 KB) Download PDF
English

Physician Fax Form
(80 KB) Download PDF
English
 
Consent for Release of Protected Health Information
(196 KB) Download PDF
English
 
Request for Restriction of Protected Health Information for Services & Treatment
(160 KB) Download PDF
English
 
How to Read your Label
(196 KB) Download PDF
English
 
Humana Health and Wellness Monthly Catalog and Order Form
(255 KB) Download PDF
English
 
Humana Health and Wellness Quarterly Catalog and Order Form
(3.1 MB) Download PDF
English
 
Humana Integrated Care Program of Illinois Health & Wellness Order Form
(518 KB) Download PDF
English
 
Humana Gold Plus Integrated Health and Wellness Catalog and Order Form
(586 KB) Download PDF
English
 
Humana Gold Plus Integrated, a Commonwealth Coordinated Care Plan, Health & Wellness Catalog & Order Form
(487 KB) Download PDF
English
 
Patient Bill of Rights
(119 KB) Download PDF
English

 

Humana Pharmacy® Specialty Forms

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