Health Forms
Required Forms For All Incoming Students (Regardless of Insurance):
Insurance Forms:
- Anthem Medical Claim Form
- Anthem International Medical Claim Form
- Declaration of Domestic Partnership
- Express Scripts Mail Order Pharmacy Form
- UC SHIP 2012-2013 Delta Dental PPO Plan Summary
- Formulary
- UC SHIP 2012-2013 Dependent Medical Plan Summary
- UC SHIP 2012-2013 Dependent Prescription Summary
- UC SHIP 2012-2013 Blue View Vision Full Plan
- UC SHIP 2012-2013 Blue View Vision Plan Summary
- Prescription Drug Claim Form
- Termination of Domestic Partnership
- UC SHIP 2012-2013 Student Medical Plan Summary
- UC SHIP 2012-2013 Student Full Medical Plan
- UC SHIP 2012-2013 Student Prescription Summary
- Voluntary UC SHIP 2012-2013 Dependent Enrollment Form
- Voluntary UC SHIP 2012-2013 Continuation Plan Enrollment Form
Links to Other Health Services Forms
UCHastings College of the Law
200 McAllister, San Francisco, CA 94102415.565.4600
©2013
