Office Administration/Patient Education Resources Order Form

Most of the information available through this form can also be found on our website at amerihealth.com/providers or on the NaviNet^® web portal. If you cannot find what you’re looking for on our website or do not have access to NaviNet, please continue completing the form below.

Your request will be processed and delivered within five to seven business days.

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Your Information

*First Name:

*Last Name:

*Title:

Provider/Office Information

*Provider/Office Name:

*Street Address 1:

Street Address 2:

*City:

*State:

*ZIP:

*County:

*NPI or 10-digit ID:

*Phone Number:

Would you like to sign up to receive email communications that announce the latest information, including Partners in Health Update^SM and provider news alerts?

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Please select the items you wish to request.

Office Administration

Manuals

Provider Manual for Participating Professional Providers:

Newsletters

Partners in Health Update^SM:

Request #1:

Request #2:

Request #3:

Patient Education

Behavioral Health Overview Guides

On To Better Health — 25/pack:

Health and Wellness Material

Alcohol Screening in Primary Care — 25/pack:

Baby FootSteps^® Program enrollment flyer — 25/pack:

Help Patients Quit Tobacco — 25/pack:

Clinical Practice Guidelines Summary:

Other materials, including forms and patient resources, are available at:

Please note that claim forms, such as the CMS-1500, are not available through the Order Form; they are available for purchase at many local office supply stores.

If you still do not see what you are looking for, or if you need to order larger quantities, please send an email to provcomm.requests@amerihealth.com.