Food As Medicine 
18 Reasons provides nutritious groceries to eligible on San Francisco Anthem MediCal Patients. This form will help us determine if you are eligible. If you have any questions or need help completing the form, please call ‪(415) 568-2713‬ or email foodasmedicine@18reasons.org.

The information requested is Protected Health Information (PHI) and is the minimum necessary to execute delivery of patient services. Please understand that as a link in the "Chain of Trust", all PHI will remain confidential as mandated by the Treatment, Payments, and Healthcare Operation Laws mandated by HIPAA. 

For more information about this benefit and eligibility, please visit https://www.anthem.com/member-resources or call 800-407-4627 (TTY 711)

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18 Reasons ofrece alimentos nutritivos a los pacientes elegibles de MediCal de Contra Costa Health Plan. Este formulario nos ayudará a determinar si usted es elegible. Si tiene alguna pregunta o necesita ayuda para completar el formulario, llame al (415) 568-2713 o envíe un correo electrónico a foodasmedicine@18reasons.org.

Para obtener más información sobre este beneficio y la elegibilidad, visite https://www.anthem.com/member-resources or call 800-407-4627 (TTY 711)


 
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