Member Forms & Tools - Washington State Local Health Insurance - CHPW
Community Health Plan of Washington Apple Health Medicaid Plan Community Health Plan of Washington Apple Health Medicaid Plan

Member Forms & Tools

We created this page to make it easier for CHPW Apple Health (Medicaid) members to find the materials they need. Bookmark this page for quick access to commonly used forms and tools, all in one spot.

Forms & Tools

Printable cards to help individuals request interpretation. Available in Arabic, Cantonese, Mandarin, Russian, Somali, Spanish, and Vietnamese.

Protected Health Information (PHI) Forms

How to Submit

Please follow the instructions noted on the form you are using, and submit via:

CHPW Medicaid Coverage Email: save the document to  your device, fill out according to directions, and email to [email protected] or the address listed on the form.
CHPW Medicaid Coverage Mail: print the document, fill out according to directions, sign the form, and mail to: CHPW, ATTN: Customer Service, 1111 3rd Ave, Suite 400, Seattle, WA 98101.


For More Information

If you have questions, can’t find what you need, or need a hard copy of materials mailed to you, please contact Customer Service: 1-800-440-1561 (TTY: 711), Monday through Friday, 8:00 a.m. to 5:00 p.m.

You may also wish to explore these additional resources:


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Sales Team

Get real answers
from real people

Phone: 1-800-440-1561
[email protected]

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