Healthy Indiana Plan Member Forms

MDwise care managers can help you make goals for your health. They work with you, your doctors, family and caregivers to do this. They want you to make the best choices for your health. Care managers can help you understand your health conditions and how to best manage them. Care management also assists you with:
• Understanding your condition.
• Understanding your medications.
• Getting supplies and equipment you need.
• Finding care from special doctors. • Getting information about your condition. • Scheduling appointments.
• Talking to doctors about your condition(s) and how you are doing. • Getting help from other organizations.

HIP Member Consent Form
MDwise Panel Add Form
Employer/Third Party Contribution Form
HIP Preventive Services Form
Care Management/Disease Management Referral Form

INcontrol forms:

Asthma Action Plan
COPD Action Plan
Diabetes Action Plan
Hypertension Know Your Numbers
Quit Smoking Diary
Congestive Heart Failure Weight Log