Forms & publications

Use this form to disenroll from Medicare Advantage.

This form directs ArrayRx to communicate with you about your personal health information at the address you select. This form does not apply to your health care provider. You must give your provider separate, specific instruction about what health information they may share and with whom.

This form directs ArrayRx to communicate with you about your personal health information at the address you select. This form does not apply to your health care provider. You must give your provider separate, specific instruction about what health information they may share and with whom.

This form directs ArrayRx to communicate with you about your personal health information at the address you select.

This form directs the Uniform Medical Plan's (UMP) administrator, Regence, to communicate with you about your personal health information (PHI).