Member forms

Documents, forms and notices for Providence Health Plan members. You may be able to fill some of these forms on your computer, then print, sign (if necessary) and submit via instructions on the form.

Consent forms

Application, plan selection and changes to existing coverage

Transition of care


Most providers bill Providence Health Plan directly, however if you must submit a medical claim to Providence, please use these forms:


Designated record set

Medical home selection

Other forms