Caregiver Forms

This form allows caregivers to work with HAP CareSource on behalf of their loved ones. 

Navigate 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.