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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.

Postal Prescription – Quick Reference Guide

Review this guide to find tips and answers to questions for medication by mail.

UHA Comprehensive Formulary

This booklet is your list of the drugs that are covered by your plan.

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.

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 Climate Service Request Form

Use this form to request a climate device (such as an air conditioner or portable heater).