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Forms

You are here: Home1 / Members2 / Forms

Member Forms

Member Services

Advance Directive

  • State of Oregon Advance Directive
  • Directiva Anticipada (Estado De Oregon) (Advance Directive Spanish Version)

Appeal and Hearing Request Form

Solicitud de apelacion y audiencia por negacion de servicios medicos (Appeal and Hearing Request Form Spanish)

Advanced Health Member Complaint Form and Information Packet

Formulario de Quejas del Plan de Salud de Oregon (OHA Spanish Complaint Form)

Administrative

Flex Fund Request

Website Privacy Policy

La Póliza de Privacidad del Sitio Web (Website Privacy Policy-Spanish)

Website Privacy Policy Large Print

Oregon Health Plan

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)

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.

Advanced Health Notice of Privacy Practices

Aviso de prácticas de privacidad (Advanced Health Notice of Privacy Practices – Spanish) Version

Advanced Health Notice of Privacy Practices Large Print

About Advanced Health

Advanced Health proudly connects Oregon Health Plan (OHP) members living in Coos and Curry counties to quality local care.

Contact Us

We are here to help!
541-269-7400
1-800-264-0014
TTY 877-769-7400
customerservice@advancedhealth.com

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  • Members
    ▼
    • Member Home
    • Find a Provider
    • Your Benefits
    • Forms
    • FAQ’s
    • Transportation
    • Community Advisory Councils
    • Active Living Program
    • Quit Tobacco Program
    • Pharmacy Info
  • Provider Home
    ▼
    • Provider Home
    • Provider Portal
    • Claims
    • Provider Forms & Resources
    • Quality Incentive Measures
    • Health Evidence Review Commission
    • OHA Prioritized List
    • Clinical Practice Guidelines
    • Pharmacy Info
    • Opioid Crisis Resources
    • Provider Trainings
    • Traditional Health Worker
  • Community Focus
    ▼
    • Our Community Health Focus
    • Coos Community Advisory Council
    • Coos Community Health Improvement Plan (CHIP)
    • Curry Community Advisory Council
    • Curry Community Health Improvement Plan (CHIP)
    • FEARsome Clinic
    • Get Involved
    • Building Self-Healing Communities
  • About
    ▼
    • About Advanced Health
    • Our History
    • Our Board of Directors
    • Clinical Advisory Panel
    • Contact Us
    • CAREERS
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