Provider Forms
Treatment Authorization Request (TAR)
Authorization Forms
Medi-Cal TAR Forms Reorder Request
Telephone Service Center
Call the California Department of Health Services 1-800-541-5555
Pharmacy Authorization
- Fax medication request forms to Pharmacy Services: 650-829-2045
- Questions and information: Pharmacy Help Line: 650-616-2088
Medication Request Forms
Health Services
Referral Authorizations
Member Services
HPSM contracted physicians need to complete this form to allow assignment of an HPSM member to their panel.
Both provider and member signatures are required.
Fax: 650-616-8581
Primary Care Physician Change Forms
HPSM members who want to change their PCP can complete this form and fax to Member Services.
Member signature is required.
Quality Programs
Claims
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