2012 Flu Shot Roster

Medication Request Form

MN Medication Request Form

Provider Change Form

Claim Reconsideration

Diabetes Eye Exam Consult Form

My Health Worksheet (fillable)

Symptom Help for Viruses

ATTENTION EYE CARE PRACTITIONERS: Sanford Health Plan is concerned with ensuring the continuity and coordination of care of our members with diabetes. In order to improve the lines of communication between our eye care professionals and our member’s primary diabetes care provider, we recommend that your clinic utilize this form in providing your patient’s primary diabetes care provider with information related to their diabetic eye exams.


All Providers (both participating and non-participating) submitting claims to Sanford Health Plan must complete a W-9 Form. You may fax this form to Sanford Health Plan Provider Relations Department at 605-328-7224.

W-9 Form