Important Documents & Forms

Forms

• Confidential Communications Member Request Form
• Request a Restriction Member Form
• Release of Protected Health Information
• Online Notification of Pregnancy Form
• UPHP Management Committee Application
• Nonopioid Directive Form – The Michigan Department of Health and Human Services has developed a nonopioid directive form. This form lets patients inform their health care providers that they do not want to receive opioids. The form can be revoked at any time by telling the provider. Individuals (or legal guardians) who want to inform a health care provider of their wish may download and complete the form and give a copy to all their health care providers, including dentists.