Member forms
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Member forms


Forms

Medicaid forms

  • Advance directive form | Español
    This form will tell your doctor and family members about the care you want to receive if you are sick or injured and cannot tell them yourself.
  • Appeals form
    A denial is a decision to not pay for a service. If you get a denial, you can appeal it using this form.
  • Complaint form | Español
    If you are not happy with the care from your provider, you can file a complaint. You can also file a complaint if you are not happy with your service from EOCCO.
  • EOCCO Flexible Services Request Form (Health Related Services)
    If you need health services that are not covered by Medicaid, your provider can help fill out this form to request services for you.

Clinical Practice Guidelines

Medical Clinical Practice Guidelines are available upon request. Please contact EOCCO Customer Service for this information.


Pharmacy forms

Questions?

Customer Service: 888-788-9821 (TTY users: 711)
Hours: Monday through Friday, 7:30 a.m. to 5:30 p.m. PST

EOCCO members should have their member ID number ready for quicker help.

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