Community Advisory Council Application
Use this form to apply to be a member of our Community Advisory Council.
Health Risk Assessment – Spanish
Los formularios de evaluación de riesgos para la salud, disponibles en inglés y español, ayudan a los miembros de Umpqua Health Alliance a compartir información sobre su salud, así como sus necesidades de atención y de apoyo.
Health Risk Assessment – English
Health Risk Assessment forms in English and Spanish help Umpqua Health Alliance members share information about their health, care needs, and support needs.
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.
UHA Riders Guide
Learn more about getting free rides to your appointments.
NEMT & BCB Brochure
Learn more about getting free rides to your appointments.
GMR Appointment Verification Form
Use this form to request gas mileage reimbursement for non-emergency medical transport (NEMT).
Postal Prescription – New Customer Order Form
Use this form to sign up for medication by mail.
Postal Prescription – Quick Reference Guide
Review this guide to find tips and answers to questions for medication by mail.
Machine-Readable Formulary
Machine-readable formulary data file (effective April 2026) for Umpqua Health Alliance’s Oregon Medicaid plan, listing covered medications with NDC codes, drug tier assignments, prior authorization requirements, step therapy, and quantity limits in a structured JSON format for interoperability.