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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 Information Sharing Authorization Form

This form gives us permission to send details about your HRSN service request to one of our partners.

Verification of Landlord/Tenant Relationship and Rent Owed

HRSN Housing Supplemental Income Worksheet

Use this form if you need to share income information for other adults in your home as part of your HRSN request.

UHA Community Health Improvement Plan

The CHP is a five-year plan to systematically address community health issues based on the Community Health Assessment (CHA).

UHA Community Health Assessment 2023

This report highlights five-year health trends in Douglas County and illustrates various health and social data indicators.

Members Handbook

Your Member Handbook has everything you need to know about being an Umpqua Health member.