• ARMHS Provider

    ARMHS Provider

    Notification / Change Request
  • MEMBER INFO

  • MEMBER ACKNOWLEDGEMENT

  • By affixing my signature below, I have decided for my ARMHS services to be delivered by the new ARMHS provider listed above. I was informed of the transfer process and all the information above is accurate to the best of my knowledge. I agree that UCare may use and release information regarding my ARMHS services to the new ARMHS provider above. If member signs with a “X“, signature of Responsible Party (RP) or witness is required.

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