Miembros de Umpqua Health

Documentos y formularios

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

Medication Management Referral Form

Referral form for submitting patients to Umpqua Health Alliance’s Medication Management Program, completed by the referring provider and submitted to UHA Pharmacy Services by fax or email.

Pharmacy Prior Authorization Criteria

Pharmacy Prior Authorization Criteria outlines requirements and clinical criteria for medications requiring prior authorization, supporting consistent review and approval decisions for covered pharmacy services.

Medication Prior Authorization Form

Prior authorization request form for prescription drugs submitted to Umpqua Health Alliance’s pharmacy team, requiring clinical documentation and provider information for formulary exceptions or non-covered medication requests.

Professionally Administered Drug (PAD) Prior Authorization Form

Prior authorization request form for professionally administered drugs (PAD), requiring supporting clinical documentation submitted to Umpqua Health Alliance’s pharmacy team by fax or phone.

Pharmacy Prior Authorization Grid

Umpqua Health Alliance’s pharmacy prior authorization grid listing prescription drug categories that require prior authorization, with fax and phone contact information and documentation requirements.

NOABD FAQs (Spanish)

Encuentre respuestas a preguntas frecuentes sobre determinaciones adversas de beneficios.

NOABD FAQs

Find answers to frequently asked questions about adverse benefit determinations.

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.

Grant Application Budget Form

Budget form for Umpqua Health Alliance grant applications, used by community partners to itemize total program costs and document how UHA grant funds and other funding sources will be allocated.