Forms & Documents - Colorado Access

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Health First Colorado and CHP+ are going back to normal renewal processes.

Check your email, mail, and PEAK inbox. Take action when you get official messages. You can see your renewal date here at any time.
If you get a renewal packet, make sure to fill it out. Make sure to also sign it and return it by the due date.
Learn more here

Members
Member Services
Forms & Documents

We want you to have quick access to the resources you need. You’ll find everything from grievance forms to reimbursement request forms here. These are the most common resources you might need. Please call us if there’s something you need that you don’t see here.

General Forms

Member Grievance
Formulario De Quejas De Miembros

Authorization to Release PHI
Autorización para la Divulgación de la Información de Salud Protegida Authorization to Release PHI – Russian

Member Reimbursement Request
Formulario de Solicitud de Reembolso del Miembro

Care Management Referral Form

Designated Client Representative Form

ADA

Member ADA Discrimination Complaint Form (please download file)
Member Request for Services (please download file)
Interpreter Request Form

Pharmacy

Prescription Drug Claim Form

Rights & Responsibilities