Skip to main content
  • For Members
  • For Providers
  • For Employers
  • For Brokers/Agents
SHL
    • Clinical Guidelines
    • Counting Kicks During Pregnancy
    • Dental Provider Guide
    • Health Care Forms
    • HEDIS Measures
    • Influenza (Flu) Vaccine Decision-Making Guide
    • Join Our Network
    • Long-Acting Injectable Medications
    • Medical Policies
    • Online Provider Center
    • Online Provider Center Tutorial
    • Opioid Programs & Resources
    • Pharmacy Benefits
    • Pharmacy Policies
    • Prior Authorizations
    • Provider Advocates
    • Provider Summary Guide
    • Quality Issues
    • Review Protocols
    • Submit/Appeal a Claim
    • Tip Sheet: Get Adults’ Vaccinations Back on Track (PDF)
    • Transplant Guidelines
    • Utilization Management
    • Women's Preventive Services
    • Mail Order Program
    • Drug Lists
    • Dental
    • Doctor or Provider
    • Pharmacy
    • Vision
Sign In
Sign In
×

More Sites

For Members
For Providers
For Employers
For Brokers/Agents
SHL

Site Search ×
Home ×
    • Clinical Guidelines
    • Counting Kicks During Pregnancy
    • Dental Provider Guide
    • Health Care Forms
    • HEDIS Measures
    • Influenza (Flu) Vaccine Decision-Making Guide
    • Join Our Network
    • Long-Acting Injectable Medications
    • Medical Policies
    • Online Provider Center
    • Online Provider Center Tutorial
    • Opioid Programs & Resources
    • Pharmacy Benefits
    • Pharmacy Policies
    • Prior Authorizations
    • Provider Advocates
    • Provider Summary Guide
    • Quality Issues
    • Review Protocols
    • Submit/Appeal a Claim
    • Tip Sheet: Get Adults’ Vaccinations Back on Track (PDF)
    • Transplant Guidelines
    • Utilization Management
    • Women's Preventive Services
    • Mail Order Program
    • Drug Lists
    • Dental
    • Doctor or Provider
    • Pharmacy
    • Vision

Health Care Forms

Download and print a health care form:

  • Allowables Request
  • APRN/PA Competency Form (PDF)
  • AZ Prior Authorization Request Form (PDF)
  • Behavioral Health Outpatient Treatment Request Form (PDF)
  • Claims Reconsideration Form (PDF)
  • Hospital Based Provider Enrollment Form (PDF)
  • HPN and SHL Provider Demographic Update Form
  • Initial Credentialing Form (PDF)
  • Medical Necessity Request Form (PDF)
  • Nevada Claim Form (PDF)
  • New Prescription Fax Order Form (PDF)
  • New Prescription Mail-in Order Form (PDF)
  • Step Therapy Exception Prior Authorization Form (DOC)
  • Pharmacy Reimbursement Claim Form (PDF)
  • Prior Authorization Form (PDF)
  • Recredentialing Form (PDF)
  • QOC Internal Referral Form (PDF)
  • Transition of Care and Continuity of Care Form (PDF)
  • Transplant Referral Fillable Form (PDF)
  • General Guidelines For Bone Marrow Transplant/Stem Cell Transplant Referrals (PDF)
  • General Guidelines For Heart Transplant Referrals (PDF)
  • General Guidelines for Kidney Transplant Referrals (PDF)
  • General Guidelines For Liver Transplant Referrals (PDF)
  • General Guidelines For Lung Transplant Referrals (PDF)

If you don't find the form you’re looking for, contact Provider Services.

HELPFUL LINKS
  • Accessibility
  • Careers
  • Fraud, Waste and Abuse
  • Legal
  • Licensing
  • Privacy
  • Quality
  • Terms of Use
PARTNERS
  • Behavioral Healthcare Options
  • UHC HPN Medicaid
  • Health Plan of Nevada
  • Southwest Medical
Contact Us

Copyright © 2025 United HealthCare Services, Inc. All rights reserved.