Miembros de Umpqua Health

Documentos y formularios

Si no encuentra lo que busca, nuestro equipo de atención al cliente puede ayudarle.

Appeals & Hearing Request (Spanish)

Utilice este formulario para enviar una solicitud de audiencia a la Autoridad de Salud de Oregón (OHA).

Appeals & Hearing Request

Use this form to submit a hearing request to the Oregon Health Authority (OHA).

UHA Complaint Form (Spanish)

Utilice este formulario para enviar una queja por escrito a Umpqua Health.

UHA Complaint Form

Use this form to submit a written complaint to Umpqua Health.

HRSN Nutrition Service Request Form

Use this form to request nutrition assistance services.

HRSN Housing Service Request Form

Use this form to request housing assistance services.

HRSN Home Changes For Health Request Form

Use this form to request a HRSN Home Changes For Health (such as an air conditioner or portable heater).

UHA Information Sharing Authorization Form

This form gives us permission to send details about your HRSN service request to one of our partners.

Verification of Landlord/Tenant Relationship and Rent Owed

HRSN Housing Supplemental Income Worksheet

Use this form if you need to share income information for other adults in your home as part of your HRSN request.