Transportation
- HSCSN Family Therapy Travel Fact Sheet [PDF - 370 KB]
- HSCSN Unaccompanied Enrollee Consent Form - English [PDF - 956 KB]
- HSCSN Unaccompanied Enrollee Consent Form - Spanish [PDF - 1.12 MB]
Pharmacy Benefits
- HSCSN CVS Mail Order Fax Form [PDF - 650 KB]
- HSCSN Formulary Prior Authorization and Exception Form [PDF - 455 KB]
Out-of-Pocket Reimbursement of Medical Costs
- HSCSN Reimbursement Request Form - English [PDF - 2 MB]
- HSCSN Reimbursement Request Form - Spanish [PDF - 2 MB]
HSCSN Benefits
- HSCSN Benefits Covered [XLS - 36 KB]
Behavioral Health Services Request Forms
- HSCSN AprilMay Referral Form [PDF - 712 KB]
Physical Health Services Request Forms
- HSCSN Rehabilitative Services Request Form [PDF - 236 KB]
Referrals
- HSCSN Out of Network Services Referral Form [PDF - 405 KB]