EAP Forms

For most efficient and timely service – use of the Enter EAP CAF flow on ProviderConnect℠ is the preferred method of submitting case activity and billing information. Faxed or mailed forms should only be submitted to the specific fax or address. For further information about using ProviderConnect for this purpose please click here.

• CAF-1 – EAP Case Activity and Billing Form
• CAF-2 – EAP Case Activity and Billing Form
• EAP Case Activity and Billing Form (CAF) Frequently Asked Questions
• Military OneSource Case Activity Form (CAF)
• Military OneSource Case Activity Form Participant Addendum (CAF-PA)
• Military OneSource Member Statement of Understanding
• Military OneSource Member Statement of Understanding (Español)
• Authorization to Disclose Health Information
• Authorized Representative Form
• Revocation of Authorization to Disclose Health Information
• Revocation of HIPAA Authorized Representative Form
• Authorization to Disclose Information for Formal or Mandatory Referrals to the EAP
• Authorization to Disclose Health Information for Formal or Mandatory Referrals to the EAP (Español)
• EAP Participant Statement of Understanding
• EAP Participant Statement of Understanding (Español)
• EAP Participant Statement of Understanding – Formal or Mandatory Referrals
• EAP Participant Statement of Understanding – Formal or Mandatory Referrals (Español)