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 Forms

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 Pharmacy Drug Authorization Request Form Pharmacy Drug Mail Order Form (English) Pharmacy Drug Mail Order Form (Spanish) Pharmacy Member Reimbursement Form (English) Pharmacy Member Reimbursement Form (Spanish)

Interoperability

Filing a Complaint About a Suspected Data BreachHow to file a complaint with the Office of Civil Rights or the Federal Trade Commission.

Interoperability Frequently Asked QuestionsInformation related to the factors enrollees should consider in selecting a health information management application.

Privacy - Strategies enrollees may use to safeguard the privacy and security of their data.