Release of Personal Health Information
Patient Registration Form
Health History Form
Patient Pain Diary - an interactive form for patients to fill out before their appointment with their provider. This form will provide information your provider will need to have to help determine the proper health care plan.
Patient Opioid History Form - an interactive form for patients to fill out before their appointment with their provider. This form will provide information your provider will need to have to help determine the proper health care plan.
Risk / managed care plans:
Basic Health, Healthy Options, Chip
Commercial (Health Maintenance Organization [HMO] / Point of Service [POS]), Secure Horizons
Uniform Medical Plan (UMP) Neighborhood
Cigna (Great West, One Health Plan)
Group Health Cooperative (GHC - May require Provider Enrollment and / or Primary Care Provider Referral)
United Healthcare / Pacificare
Humana Choice Care
Coventry Health Plans / First Health
Private Healthcare Systems (PHCS)
Department of Social and Health Services (DSHS)
Managed Medicaid programs:
Community Health Plans Claims (CHP)
Group Health Cooperative (GHC)
Molina Healthcare of California (MHC)
Regence Blue Shield (RBS)
Managed Medicare Products (Patients should check with their Medicare plan to verify if their Franciscan Medical Group provider is listed with the plan. Note that many Managed Medicare, HMO Medicare Plans and Out-of-Area plans will require a special referral.)
Meidcare Fee for Service (FFS)
Contracted Managed Medicare:
Subject to Provider Enrollment. Referral may be REQUIRED.
Community Health Plans (CHP)
Humana Medicare Choice
Molina Medicare Advantage
Regence Medicare Advantage
Military & Veteran Affairs (VA) programs
Tricare / TriWest
Veteran’s Administration (VA) (Champ VA, Department of Veterans)
Labor & Industries
We bill most insurance plans directly. However, in order to avoid any unexpected charges, we recommend you find out about co-payment policies and familiarize yourself with any restrictions regarding self-referrals.
Our clinics make services available to all individuals, regardless of their ability to pay. If you would like more information about how we can assist you with your bill, please talk to the receptionist when you visit a clinic. The receptionist can direct you to a patient account representative, who will help you evaluate your payment options. For your convenience we accept cash, check, or credit card.