Forms & Brochures
(Click here to list the forms in Alphabetical order)
Benefit enrollment forms
- Address Change Form
- Benefits Revision Form
- Employee Enrollment/Change Form - Clerical & Technical, Service & Maintenance
- Employee Enrollment/Change Form - Faculty, Managerial & Professional
Health information services forms
- Health Information Release Form
- Health Information Request Form
- Mental Health & Counseling Records Release Form
OB/GYN forms
- Genetic Screening Form
- Instructions for 1 hour Glucose tolerance test
- Instructions for 3 hour Glucose tolerance test
- Ultrasound Instructions
Pediatric forms
- Child Health Record
- Health Assessment Record - CT Department of Education
- Early Childhood Health Assessment Record
- Authorization for the Administration of Medicine by School Personnel
- Sports Participation Health Record
- Youth Camp Health Exam/Record
- Yale Health Plan Initital History Questionnaire
Travel forms
Other forms
- Comment Card
- Claim Form
- Pharmacy Claim Form for Staff & Faculty Members
- Mail Order Enrollment Form
- Retiree Major Medical Claim Form
- Acknowledgement Form Receipt of NOPP
- NOPP Notice
- Accounting for Disclosures of PHI form
- Insurance Information Update Form (COB)
- Advance Directives Forms
Brochures
Patient Information
- Advance Directives Brochure
- Inpatient Care Facility (ICF) Brochure
- Outpatient Care and Services Brochure
- Colonoscopy Prep Instructions
- Sigmoidoscopy Prep Instructions
