Documents & forms
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Registration & Prescription Order Form
- (624 KB) Download PDF
- English | Español
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Physician Fax Form
- (80 KB) Download PDF
- English | Español
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Consent for Release of Protected Health Information
- (196 KB) Download PDF
- English
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Request for Restriction of Protected Health Information for Services & Treatment
- (160 KB) Download PDF
- English
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How to Read your Label
- (196 KB) Download PDF
- English | Español
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2023 Humana Health and Wellness Catalog and Order Form
- (1.1 MB) Download PDF
- English | Español
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2023 IL Humana Gold Plus Integrated Health and Wellness Catalog and Order Form
- (586 KB) Download PDF
- English | Español
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2023 Florida DSNP Over-the-Counter (OTC) Health and Wellness Product Order Form
- (586 KB) Download PDF
- English | Español
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2023 Humana Healthy Horizons® in Louisiana Health and Wellness Catalog and Order Form
- (586 KB) Download PDF
- English | Español
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2023 Humana Healthy Horizons® in South Carolina Health and Wellness Catalog and Order Form
- (991 KB) Download PDF
- English | Español
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Patient Bill of Rights
- (119 KB) Download PDF
- English
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View all CenterWell Pharmacy® Specialty Forms