Member Handbooks and Forms

Member Handbooks

• Buckeye Member Handbook - English (PDF)
• Buckeye Member Handbook - Spanish (PDF) - Coming Soon

• Additions to the Member Handbook Insert (PDF)
• Member Termination Changes Insert (PDF)

Member Forms

• Health Information Form (complete online)
• Change Your PCP (complete online)
• Appointment of Representative Form (PDF)
• Authorization to Use and Disclose Health Information (PDF)
  

Pregnancy Forms

• Notification of Pregnancy Form (complete online)

Immunization Schedules

• Immunizations – Adult Schedule - English (PDF)
• Immunizations – Adult Schedule - Spanish (PDF)

• Immunizations – Ages 0 – 6 Schedule - English (PDF)
• Immunizations – Ages 0 – 6 Schedule - Spanish (PDF)

• Immunizations – Ages 7 – 18 - English (PDF)
• Immunizations – Ages 7 – 18 - Spanish (PDF)

• ImpactSIIS Brochure for Parents (PDF)

Other Resources

• Cold Remedies and Checklist Guide (PDF)
• Office Visit Checklist (PDF)