Documents and forms
You can find and complete many forms on the WellSense member portal.
If you'd rather download and print a paper copy, find your form from the list below.
Fitness/WeightWatchers®
Diapers
Medical
- Prescription Drug Reimbursement Form
- Mail Order Program Enrollment Form
| Title | Language |
|---|---|
| Care Needs Screening You can also complete your Care Needs Screening online. |
English |
| Allow Care Management to Obtain Protected Health Information Formulario de Autorización de PHI para Programa de Manejo de Cuidado Fòmilè Otorizasyon Jesyon Swen ESP Formulário de autorização de PHI para gestão de atendimentos Quản lý Dịch vụ Chăm sóc Mẫu đơn Ủy quyền PHI 照護管理 PHI 授權表 |
|
| Assign an Appeals Representative Formulario de Autorización de Representante para Apelación |
English Spanish |
|
Assign and Revoke a Personal Representative |
English Spanish Portuguese Haitian Creole |
| Release of Reproductive Healthcare Attestation | English |
| Request for Access to Information | English Spanish |
| Request for Restriction of Information or Confidential Communication | English |
| Request to Release Information Formulario de divulgación de información Formulário de Divulgação de Informações Fòm pou Pibliye Enfòmasyon |
English Spanish Portuguese Haitian Creole |
*Please see the MassHealth Member Handbook and MassHealth Covered Services List for additional information, including which benefits, services and medications are covered or non-covered on our plan- and any restrictions or guidelines we must follow before providing them. You can find doctors and hospitals in our network here, see our privacy policies, and learn how we make sure you get the right care at the right time with our Utilization Management policy.
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