Due to the current government shutdown, we want to let you know that updates to your Medicare account may take longer than usual. Learn more about how this may affect your services.
Additional Member Forms | Allwell from Western Sky Community Care
Additional Forms
Use this form when you want to allow us to share your health information with a person or group:
Use this form when you want us to cancel or revoke your previous permission to share health information with a person or group:
- PHI Revocation Form - English (PDF) - last updated Oct 10, 2018
- PHI Revocation Form - Spanish (PDF) - last updated Jan 15, 2021
If you have questions please, contact Member Services.
If you have questions please, contact Member Services.