View Forms in Espanol
 
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
 
2016 Humana Health and Wellness Order Form
(255 KB) 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
 
Florida DSNP OTC Health and Wellness Products
(215 KB) Download PDF
English
 
Patient Bill of Rights
(119 KB) Download PDF
English

 

Humana Pharmacy Specialty Member Forms

Consent for Release of Protected Health Information
(252 KB) Download PDF
English
 
Request for Restriction of Protected Health Information
(39 KB) Download PDF
English
 
Patient Bill of Rights
(119 KB) Download PDF
English