INTEGRAL HEALTH ASSOCIATES
Magellan Health - Members' Rights and Responsibilities Statement
Members have the right to:
Members have the responsibility to:
* This standard is required for our Condition Care Management (CCM) products.My signature below shows that I have been informed of my rights and responsibilities, and that I understand this information.Signature of patient, parent or legal guardian (Click on signature line):Signature* The signature below shows that I have explained this statement to the patient. I have offered the member a copy of this form. ________________________________Provider Signature