DC Healthy Families and DC HealthCare Alliance Enrollment Services

Forms

The following forms are available in PDF format. Adobe Reader is required to view and use these forms and is available to download here.

	Plan Selection Forms English Amharic Chinese Korean Spanish Vietnamese
	Enrollment Form English Amharic Chinese Korean Spanish Vietnamese
	Health Care Needs of Children in DC Medicaid English Amharic Chinese Korean Spanish Vietnamese
	Personal Health Assessment Form English Amharic Chinese Korean Spanish Vietnamese
	Fee-for-Service Continuation Form English Amharic Chinese Korean Spanish Vietnamese