Use the links below to access some of the most popular CommunityCare Prescription Drug Plan forms. If you can't find the form you're looking for, please contact us for assistance.
- Claim Form
- Oklahoma Advance Directive for Health Care
- Appointment of Representative Form
- Auto Bank Draft Authorization
- Pre-Enrollment Checklist
- Individual Election Form
- Medication Log
- Coverage Determination Request Form - updated 12/12/2019
- Protected Health Information (PHI) Authorization Form
- Part D Appeal Request Form - updated 9/26/2019
- Request for Disenrollment
- SAA/RRB Withhold Form
Forms will open in a new window and require Acrobat Reader to view.
Although Medicare is a Federal program, CommunityCare Prescription Drug Plan is available only to individuals who live in our plan service area. To stay a member of our plan, you must keep living in this service area.
The CommunityCare Prescription Drug Plan service area includes: State of Oklahoma
If you plan to move out of the service area, please contact Customer Service at 918-594-5202 or 1-800-333-3275. TTY/TDD users should call 1-800-722-0353.