BadgerCare Plus and/or Medicaid SSI Members Forms

Downloadable forms

• Authorization for Disclosure of Protected Health Information form
• Appointment of representative for appeal form (PDF)
• Postpartum Checkup Incentive form (PDF)

Forms in Quartz MyChart

Get secure and convenient access to member forms and resources through Quartz MyChart.

• Send a message
• Change Your Address (Also, update your address by contacting ForwardHealth or using the MyACCESS app.)
• Change Your primary care provider (PCP)
• Order printed materials
• Other insurance questionnaire

Newsletters

• Summer 2023 (English | Espanol)
• Summer 2022 (English | Español)

Protected Health Information (PHI) Authorization

• You have the right to allow someone else to access your Protected Health Information (PHI). To do so, please complete and submit the Authorization for Disclosure of Protected Health Information form at QuartzBenefits.com/PHIform or in Quartz MyChart.
• You may also print and mail the Authorization to Disclosure of Protected Health Information form and send it to Quartz.