Grand Rapids Popcorn Recalls PCA's 30# Cases of Medium Chop Granulated Peanuts Sold in Michigan and Florida because of Possible Health Risk - February 5, 2009 Close

SAP | Statutory Authority | How it works | FAQ | Forms | Links

Forms

For Subscribers:

Request for Review and Release (24K PDF)

Appointment of Representative (12K PDF)

Survey of the Program for previous Participants

For Managed Health Care Organizations:

Managed Health Care Response Form (20K)

Managed Health Care Quarterly Grievance Report (76K PDF)
Managed Health Care Quarterly Grievance Report - Interactive Form* (226K)
*Interactive Forms can be completed on your computer and printed with the inserted information. However, they cannot be electronically saved and retain the inserted information.

For Physicians:

Work Authorization and Invoice Form (31K PDF)

 

Adobe Acrobat is required to view and print PDF files.

Top

SAP | Statutory Authority | How it works | FAQ | Forms | Links