Description | Form | |
| Enrollment application form. This PDF form allows you to type directly onto it before printing. All other forms (below) must be printed first and then hand written. | Johns Hopkins US Family Health Plan application form | |
| Allotment Authorization form | Download the Allotment form | |
Johns Hopkins US Family Health Plan Authorization for use and disclosure of Protected Health Information (PHI).
| USFHP Authorization Explanation Letter Authorization for Release of Health Information - Standing | |
| If you are ever required to pay a provider use this form, along with a copy of your receipt for full reimbursement. | Johns Hopkins US Family Health Plan Reimbursement Form | |
| Pharmacy: Home delivery is available for up to a 90-day supply of approved medications through Rite Aid at Wyman Park. Home delivery is best suited for medications you take on a regular basis. | Mail order form | |
| Brand-name drugs with a generic equivalent may be dispensed only if your physician submits a medical necessity request and approval is granted by USFHP. | Pharmacy Prior Authorization Form | |
| In the event that you fill a prescription at a non-network pharmacy due to an emergent situation, you may seek reimbursement for incurred cost | ||
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