JeffCare Service Forms

Authorization for ROI To/From JPHSA

________________________________________________________________

Authorization for ROI Two-Way

________________________________________________________________

PelEX Opt-Out Disclosure (English Version)

PelEX Opt-Out Disclosure (Spanish Version)

________________________________________________________________

JeffCare Acknowledgement & Consent

________________________________________________________________

JeffCare Health Services Handbook (English Version)

JeffCare Health Services Handbook (Spanish Version)