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My Care Alabama Northwest

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  • My Care Alabama Northwest_Medical Management Meeting Schedule Q1 to Q4 (Yr 2022 2023) application/pdf (204 KB)
  • Specialist Referral Northwest (Please read the information on My Care Northwest Specialist Referral page before completing this form) application/pdf (975 KB)
  • My Care Provider Referral Form Northwest application/pdf (517 KB)
  • My Care Alabama Northwest PCP Agreement Out of State application/pdf (161 KB)
  • My Care Alabama Northwest PCP Agreement application/pdf (385 KB)
  • My Care Alabama Northwest DHCP Out of State application/pdf (190 KB)
  • My Care Alabama Northwest DHCP Non-Delivery Agreement application/pdf (194 KB)
  • My Care Alabama Northwest DHCP Delivery Agreement application/pdf (377 KB)
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Notices

You have the right to see any Primary Care doctor no matter where the doctor is located. You have the right to pick any Alabama Medicaid doctor to deliver your baby no matter where the doctor is located. You have the right to pick any Alabama Medicaid doctor or clinic for birth control services. You do not have to use your personal primary doctor for birth control or family planning services. You do not need approval or a referral from your personal primary care doctor to get birth control or family planning services. Care Coordination services are provided in the county where you live.

My Care Alabama Central, My Care Alabama East, and My Care Alabama Northwest complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

Auxiliary aids and services are available upon request free of charge. Toll Free: 1-800-874-9426 and TTY: 711

Language interpretation and translation services are available upon request free of charge. Toll Free: 1-800-874-9426 and TTY: 711

More information regarding these notices:

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