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Forms for AlohaCare Members

Find forms that you may need to fill out and return to AlohaCare.
  1. Appointment of Representative: This form gives permission for a person to act on your behalf to file a grievance, appeal or coverage determination for you. 
  2. Protected Health Information (PHI) Authorization Form: Give AlohaCare permission to release your private health information to another person that you designate.

  3. Member Grievance Form: Let us know if you are unhappy with the services you receive from AlohaCare or your doctor.