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 – 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.