The forms listed below as individual PDFs can also be found at Section 12 of the Neighborhood Provider Manual.

Member Services Department Request Forms
Member Site Change Request Form
Member Education Request Form
RIte Care Interpreter Services Fax Request Form
RIte Care Taxi/Van Transportation Authorization Form

Provider Services Request Forms
New Practitioner Education Form
On-call Provider Group Notification Form
Practitioner Termination Notification Form
Changes to Billing Address/Tax Identification Number Notification Form

Medical Management Request Forms

Ambulance Request Form

Breast Reduction

Continuity of Care Authorization Request

Diabetes Eye Exam Communication Form for Specialists
Diabetes Eye Exam Communication Form for Primary Care Providers
DME: Nutritional Supplement
DME: Nutritional Supplement Out of Network

Gastric Bypass
Genetic Testing

Home Care
Home Care Prior Authorization Request for Skilled Block Hours
Home Health Aide Prior Auth Request for Block Hours
Hospice Prior Authorization Request

Outpatient PT/OT Authorization Reques
Outpatient PT/OT/ST Authorization Request to Supplement School Based Services
Outpatient Rehab Request
Outpatient Speech Therapy Authorization Request
Oxygen for Pediatric Form

Pain Management Request
Physician Certification Form
Prenatal Request Form
Prenatal Supplemental Risk Referral Form
Prior Authorization for Gastric Bypass Surgery Request Form

Request for Weight Management Program

Synagis Enrollment

Termination of Pregnancy Physician Form Pregnancy Resulting from Rape or Incest
Termination of Pregnancy Physician Form Preservation of Mother's Life

Vision Request Form

Behavioral Health Request Form
Primary Care Provider Behavioral Health Communications Form