CHP Retiree Advantage (HMO)

Appointment of Representative Form Instructions

An advanced directive ensures that both medical professionals and your loved ones understand the end-of-life decisions you want in the event you’re unable to explain them due to a medical emergency. An advanced directive is simply a statement, made while you are competent, about the medical treatment you want if you can’t make those decisions later. Decisions made early and communicated plainly may have tremendous value for you and your family.

For instructions on how to use the form to appoint a representative, visit Appointment of Representative Form Instructions.

Privacy Notice - We believe our members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential.

Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.