NJ FamilyCare Member Handbooks, Forms, and Documents

Member Handbooks

• Member Handbook - English (PDF)
• Member Handbook - Spanish (PDF)

Member Documents and Forms

• Over the Counter Catalog - English (PDF)
• Over the Counter Catalog - Spanish (PDF)

• Health Risk Assessment Form - English (PDF)
• Health Risk Assessment Form - Spanish (PDF)

• Member Medical Reimbursement Claim Form - English (PDF)
• Member Medical Reimbursement Claim Form - Spanish (PDF)

• Appointment of Representative Form - English (PDF)
• Appointment of Representative Form - Spanish (PDF)

• Member Appeal Request Form – English (PDF)
• Member Appeal Request Form – Spanish (PDF)

• Appeals and Grievances - English (PDF)
• Appeals and Grievances - Spanish (PDF)

• NJ Medicaid Fidelis Care School Supply Brochure - English (PDF)
• NJ Medicaid Fidelis Care School Supply Brochure - Spanish (PDF)

Request Appointment Assistance

• Online:
  • Appointment Assistance Request - English
  • Appointment Assistance Request - Spanish
• By Fax:
  • Appointment Assistance Request Form - English (PDF)
  • Appointment Assistance Request Form - Spanish (PDF)

Medicaid Provider Directories

• Provider Directories by County
• Specialty Provider Directories