|
Welcome to the Administrative Lists and Commonly Used Forms page, an on-line resource for Arizona Foundation for Medical Care's (AFMC) physicians, hospitals, ancillary facilities, administrators and office staff.
This page has been designed with you in mind. We want to assist you with reducing administrative burdens by continuously improving processes, and providing one place to find information, tools, and forms.
Please contact AFMC's Call Center Provider Unit at 602-252-4042 or 800-624-4277.
Note: Most of the documents posted on AFMC's Web site are available for viewing or printing in Adobe PDF format. If you do not have Adobe Reader installed on your computer, please download from here for free:
Please click on the title of the guide or document to view it.
On occasion, providers will need to complete forms for specific items. You may fill out and print the necessary form(s) by clicking on your selection below.
Disclosure of PHI 560 KB - AFMC is happy to offer the physician community and their patients the convenience of filling out and printing the “Authorization for Use or Disclosure of Protected Health Information” form on-line. The process is easy. Simply click on the pdf above, read the directions, fill out the form, print, sign and return to AFMC. It’s as simple as that!
| Fee Schedule Request Form 948 KB - Use this form to request a fee schedule from AFMC. Simply click on the pdf above, read the directions, fill out the form, print, sign and return to AFMC. Don't forget the required documentation we need to process the form!
| Provider Change Form 1043 KB - A form to keep AFMC informed about current practice information such as a change of address, Tax ID#, or specialty change.
|
|
