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Welcome to Summit Health

Forms


* Please note that Moda performs some administrative functions for Summit Health. Contact us if you need more help.

Administrative forms


General forms

  • Advance Directive - A patient’s wishes for their care, should they be too ill or hurt to express it themselves
  • Coordination of benefits form - Allows a partner’s or spouse’s coverage to help cover a procedure for a patient
  • Transition of care form - For patients transitioning on to a new plan. This form may also be used for a continuity of care request form for providers terming from network.


Authorization forms


Manuals


Behavioral Health forms

Last updated Oct. 1, 2021
H2765_4006

Contact us

Have questions? We’re here to help. Call us today at 844-827-2355 (TTY users, please call 711). Our customer service team is available from 7 a.m. to 8 p.m., Pacific Time, seven days a week from Oct. 1 to March 31. After March 31, your call will be handled by our automated phone system on weekends and holidays.

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