Oregon Health Authority Forms

This form is used for provider enrollment attachment for durable medical equipment (DME) in Oregon.

This form is used for providers who are applying for enrollment as an independent radiology provider in the state of Oregon.

This Form is used for attaching school medical information to the Provider Enrollment in Oregon.

This form is used for provider enrollment attachment for targeted case management in the state of Oregon.

This document is used for renewing benefits for the Oregon Health Plan in Oregon.

This Form is used for designating an authorized representative and alternate payee for Oregon residents of Cambodian descent.

This form is used for designating an authorized representative and alternate payee for Oregon residents who speak Somali.

This Form is used for authorizing the use and disclosure of individual information in Oregon. It is available in Bosnian language.

This Form is used for authorizing the use and disclosure of individual information in Oregon. It is available in Russian language for Russian-speaking residents.

This form is used for authorizing the use and disclosure of individual information in the state of Oregon, specifically for individuals who speak Vietnamese.

This Form is used for authorizing the use and disclosure of individual information in Oregon for individuals of Cambodian descent.

This form is used for authorizing the use and disclosure of individual information in the state of Oregon, specifically for individuals of Lao ethnicity.

This form is used for receiving approval notice for temporary Oregon Health Plan coverage in Chinese Simplified language.

This Form is used for notifying the Oregon Health Plan about a pregnancy for individuals belonging to the Mien community in Oregon.

This document is a pregnancy notification form for the Oregon Health Plan in Oregon. It is available in Somali language.

This document is used for notifying the Oregon Health Plan about a pregnancy. It is called the OHP3360 Oregon Health Plan Pregnancy Notification Form.

This form is used for requesting prior authorization for medications and oral nutritional supplements in Oregon.

This document is a form that is used for creating an Oregon Advance Directive for Health Care specifically designed for individuals who speak Chuukese. It allows individuals to make decisions about their future health care in the event that they are unable to do so.

This form is used for creating an advance directive for health care in the state of Oregon. It is specifically provided in the Hmong language for those who prefer to use Hmong as their primary language. The form allows individuals to make decisions about their future medical treatment and appoint a health care representative.

This form is used by parents in Oregon to provide necessary details about their newborn baby for the official birth record. It includes all the pertinent information such as the baby's full name, date and place of birth, as well as parents' identification information.

This form is used for appointing an authorized representative and alternate payee in Oregon for the Mien community.

This Form is used for designating an authorized representative and alternate payee in the state of Oregon, particularly for Russian speakers.

This Form is used for appointing an authorized representative and alternate payee for Oregon in the Punjabi language.

This document is used for authorizing the use and disclosure of individual information in Oregon, specifically for Korean language purposes.

This form is used for healthcare provider staff in Oregon to provide assistance with applications.

This form is used for justifying the need for a positioner to assist in standing for individuals in Oregon.

This document is an Emergency Notification Form for Oregon's Health Plan in Oregon. This form is used to notify the plan about emergencies.

This document is used for notifying the Oregon Health Plan about a pregnancy. It is specifically designed for individuals who speak Burmese.

This form is used for ordering forms from the Oregon MSC8100 Forms Repository.

This document is an Advance Directive Form in large print, specifically designed for residents of Oregon. It is used to provide instructions about medical treatment preferences in case the individual becomes unable to communicate their choices in the future.

This document is a temperature log specifically designed for recording the temperature inside a refrigerator. It is measured in Celsius and is specifically used in Oregon.