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Nurse Hotline

888-516-6166

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Umpqua Health Members

Documents & Forms

If you can’t find what you’re looking for below, our Customer Care team can help.

UHA Community Health Improvement Plan – Spanish

El CHP es un plan de cinco años para abordar sistemáticamente los problemas de salud de la comunidad basándose en la Evaluación de Salud Comunitaria (CHA).

HRS Flex Assistance Request Form

Use this form to submit a request for assistance through the HRS Flex services program.

Notice of Privacy Practices

This notice describes how your medical information may be used and shared and how you can access this information.

Members Handbook – Machine Readable

Appeals and Hearings Flowchart

Learn more about the process we follow for appeals and hearings.

Community Advisory Council Application

Use this form to apply to be a member of our Community Advisory Council.

Health Risk Assessment (HRA) – Spanish

La HRA se utiliza para ayudarnos a comprender sus necesidades como miembro de Umpqua Health.

Health Risk Assessment (HRA)

The HRA is used to help us understand your needs as an Umpqua Health member.

GMR Appointment Verification Form – Spanish

Utilice este formulario para solicitar el reembolso del kilometraje de combustible para el transporte médico no urgente (NEMT).

NEMT & BCB Brochure – Spanish

Obtenga más información sobre cómo obtener viajes gratuitos a sus citas.

UHA Riders Guide – Spanish

Obtenga más información sobre cómo obtener viajes gratuitos a sus citas.