AvMed makes it easy to manage your account by providing forms and other tools for making requests. Simply print and fill out one of our pre-composed forms for quick, easy service. Certain requests can be submitted directly online.
Individuals and Families
Appointment of Representative Form
Designated Record Set (DRS) Request
Medical Benefit Drugs Requiring Prior Authorization
Medical Drug Authorization Request Form
Pharmacy Medical Necessity Request Form
Authorization to Disclose Protected Health Information
Pharmacy Drug Authorization Request Form
Pharmacy Drug Mail Order Form (English)
Pharmacy Drug Mail Order Form (Spanish)