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BCN Physician Selection Form
Who is this for?
This form is for members who have their own HMO coverage. Use it to select or change your primary care physician.
Access the form here: Physician Selection form (PDF)
What you’ll need:
- Your enrollee ID card
- A printer to print the form
- An envelope and postage to mail the form, or a fax machine. Each form includes instructions on where to send it.
If you have any questions, please contact us.
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