Oregon Health Authority Forms

This document is an approval notice for temporary Oregon Health Plan coverage in Oregon. It is available in Russian.

This form is used for declaring the intent and agreement to serve as a hospital presumptive eligibility site in Oregon.

This type of document is a Denial Notice for temporary Oregon Health Plan (OHP) coverage in Chinese Simplified language. It is used to inform individuals that their application for OHP coverage has been denied in Oregon.

This form is used to provide a denial notice for temporary Oregon Health Plan coverage in the Somali language.

This document is used for notifying the Oregon Department of Human Services/Oregon Health Authority about nursing facility residents who have chosen hospice care.

This Form is used for notifying individuals of the denial of temporary coverage under the Oregon Health Plan in Oregon. The form is available in Russian.

This form is used to provide a denial notice for temporary Oregon Health Plan coverage in Oregon for Chinese speakers.

This form is used for Medicare/Medicaid billing invoices for medical practitioner claims in Oregon. It is used to submit claims for payment to the appropriate government healthcare programs.

This form is used for requesting the termination of Medicare Advantage and Medicare Special Needs Plan enrollment in Oregon.

This form is used for enrolling in a Medicare Advantage Plan in Oregon.

This Form is used for requesting presumed eligibility for temporary medical assistance from hospitals in Oregon. (Spanish)

This document is a Medicare Advantage Plan Election form specifically for residents of Oregon who speak Russian. It allows individuals to enroll in a Medicare Advantage Plan in Oregon.

This Form is used for applying for temporary medical assistance at a hospital in Oregon. It is available in Chinese Simplified.

This document is used for applying for temporary medical assistance in Oregon for individuals who are in need of hospital services. It is available in Somali language.

This form is used for authorizing administrative examination or report requests for medical records in Oregon.

This form is used for conducting a comprehensive psychiatric or psychological evaluation in the state of Oregon. It helps gather information about a person's mental health history, symptoms, and potential treatments.

This form is used for Chinese-speaking residents in Oregon to apply for temporary medical assistance at hospitals.

This form is used for selecting a Medicare Advantage plan in Oregon. It is available in Vietnamese language.

This Form is used for applying for temporary medical assistance in Oregon for individuals without insurance.

This form is used for reporting the mental residual function capacity of an individual in Oregon. It includes details about their ability to perform tasks related to mental functions. This information is important for determining eligibility for certain benefits and services.

This Form is used for authorizing the release of medical records for an administrative medical examination in Oregon.

This form is used for obtaining informed consent from a patient undergoing a hysterectomy procedure in the state of Oregon.

This form is used for obtaining consent for a hysterectomy procedure in the state of Oregon.

This Form is used for obtaining consent for sterilization for individuals aged 21 and up in the state of Oregon.

This form is used for reporting on eye examinations in the state of Oregon. It is necessary for documenting the results and findings of an eye examination.

This form is used for requesting non-emergent medical transportation for completing an administrative medical examination in Oregon.

This form is used for reporting the physical residual function capacity in Oregon.

This document is used to authorize sterilization for individuals aged 15-20 in Oregon.

This Form is used for rating and reporting the severity of impairments in Oregon.

This Form is used for conducting a lead risk assessment in the state of Oregon. It helps identify potential lead exposure hazards in a residential or commercial property.

This Form is used for keeping track of medical records in Oregon. It helps ensure that all necessary documents are in place for a patient's medical history.

This Form is used for obtaining consent for sterilization in Oregon for individuals between the ages of 15-20.

This form is used for attaching provider enrollment information for behavior rehabilitation services in the state of Oregon.

This Form is used for enrolling health centers in Oregon and is an attachment to the OHP3104 Provider Enrollment Form.

This Form is used for providers in Oregon to disclose their ownership and control information, business transactions, and criminal convictions. It helps ensure transparency and compliance in the healthcare industry.

This Form is used for hospitals in Oregon to attach additional information when enrolling as a provider under the Oregon Health Plan.