AlaskaCare Retiree Forms
Other Forms
- Authorization for the Use and/or Disclosure of Protected Health Information (PHI)
- Authorization for the Use and/or Disclosure of PHI [PDF 129K]
- Authorizes the state AlaskaCare office to provide PHI to persons you indicate on this form
- Behavioral Health Outpatient Treatment
- Behavioral Health Outpatient Treatment Request Form [PDF 391K]
- Request behavioral health outpatient treatment
- Provider Nomination Form
- Provider Nomination Form [PDF 20K]
- Submit this form to nominate a provider not currently participating in the Beech Street Network