Medical Forms Download Area

All downloads are in the Adobe Acrobat PDF format.  Viewing documents requires the Acrobat Reader that can be downloaded from the Adobe website.
 

Medical Claim Form  
Dental Claim Form
Vision Claim Form
Link to RXSolutions.com

RXsolutions prescription order form

Workers Compensation Medical Care Booklet
Workers Compensation Medical Care Fact Sheet
Family Medical Leave Act information video
Medical PPO directory for San Francisco Peninsula
Medical PPO directory for Easy Bay Area
Medical PPO directory for South Bay Area
Medical PPO directory for North Bay Area

 

USE AND DISCLOSURE OF HEALTH INFORMATION

Very important notice regarding the Local 16 Trust's
compliance with the federal HIPAA privacy rules.