Caregiver Forms
This form allows caregivers to work with HAP CareSource on behalf of their loved ones.
Member Consent/HIPAA Authorization Form
- Grants permission for HAP CareSource to speak with a caregiver about a member’s medical, payment or protected health information.
- A HAP CareSource member or appointed representative may complete this form when applicable.
Member Services: 1-833-230-2053 (TTY: 711), 24 hours a day, seven days a week.