Azfmc

On occasion AFMC will ask you to complete forms for specific items. You may fill out and print the necessary form(s) by clicking on your selection below.

To obtain a form by fax or e-mail, contact AFMC’s Call Center, between the hours of 8 am – 5 pm, Monday – Friday, Mountain Standard Time.

Providers

  • PDF iconPrivacy Notice Form.pdf

    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!

  • PDF iconGeneral Registration and Claims Status
  • PDF iconDelegated Provider Change Form.pdf

    GROUP Providers should use this form to notify Arizona Foundation of provider changes, such as address, phone or email.

  • PDF iconFee Schedule Request Form

    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!

  • PDF iconProvider Change Form.pdf

    A form to keep AFMC informed about current practice information such as a change of address, Tax ID#, or specialty change.

Payors