Member Forms
ADVANCE DIRECTIVE
- Advance Directive Booklet
- Oregon Advance Directive User Guide
- Su guía para la Directiva anticipada de Oregon para la atención médica (Oregon Advance Directive User Guide Spanish Version)
- Advance Directive (State of Oregon Version)
- Directiva Anticipada (Estado De Oregon) (Advance Directive Spanish Version)
- Advanced Health Advance Directive Policy and Procedure
APPEAL FORMS AND COMPLAINT PACKETS
OREGON HEALTH PLAN FORMS
- Release of Information
- Autorización para el uso y divulgación de información personal (Release of Information Spanish)
- Client Agreement to Pay for Health Services
- Acuerdo del cliente para pagar los servicios de salud (Client Agreement to Pay for Health Services Spanish)
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ADVANCED HEALTH NON-DISCRIMINATION POLICY
CCO STRUCTURE AND OPERATIONS INFORMATION
OTHER MEMBER FORMS
- Flex Fund Request Form – Automated Process
- Flex Fund Request Form – Manual Process
- Servicios relacionados con la salud: Solicitud de servicios de financiamiento flexible “Flex Fund” (Spanish Flex Fund Request Form)
Health Risk Assessment (HRA) Surveys
NOTICE OF PRIVACY PRACTICES
Advanced Health is committed to protecting your information. Please see the following document in English and Spanish that explains how we protect your health information and explains your rights and our responsibilities.