BadgerCare Plus and/or Medicaid SSI Members Forms

Downloadable forms
Forms in Quartz MyChart

Get secure and convenient access to member forms and resources through Quartz MyChart.

Protected Health Information (PHI) Authorization
  • You have the right to allow someone else to access your Protected Health Information (PHI). To do so, please complete and submit the Authorization for Disclosure of Protected Health Information form at or in Quartz MyChart.
  • You may also print and mail the Authorization to Disclosure of Protected Health Information form and send it to Quartz.

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