Umpqua Health Providers

Documents & Forms

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

Patient Privacy and Security Resources – Supporting Payers Educating their Patients

CMS resource guide supporting health plan payers in educating members about patient privacy, data security, and rights under the Interoperability and Patient Access Final Rule.

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.

UHA Comprehensive Formulary

Umpqua Health Alliance Formulary (Preferred Drug List) provides information on covered medications, coverage rules, and formulary status to help members and providers make informed pharmacy decisions.

Informed Consent Form – Consent to Sterilization for Members 15 – 20

Oregon Health Plan informed consent form for sterilization procedures for members ages 15–20, meeting federal Medicaid requirements and informing patients of their right to withdraw consent at any time.

Informed Consent Form – Consent to Sterilization for Members 15 – 20 (Spanish)

Formulario de consentimiento informado en español para procedimientos de esterilización para miembros del Plan de Salud de Oregon de 15 a 20 años, conforme a los requisitos federales de Medicaid.

Informed Consent Form – Consent to Sterilization for Members 21+ (Spanish)

Formulario de autorización de esterilización en español para miembros del Plan de Salud de Oregon de 21 años o más, conforme a los requisitos federales de Medicaid sobre consentimiento informado.

Informed Consent Form – Consent to Sterilization for Members 21+

Oregon Health Plan informed consent form for sterilization procedures for members ages 21 and older, meeting federal Medicaid requirements and disclosing the permanent nature of the procedure.

Informed Consent Form – Hysterectomy Consent (Spanish)

Formulario de consentimiento para histerectomía en español del Plan de Salud de Oregon, con secciones para pacientes que pueden otorgar consentimiento y para situaciones de emergencia, conforme a los requisitos de Medicaid.

Informed Consent Form – Hysterectomy Consent

Oregon Health Plan informed consent form for hysterectomy procedures, including sections for patients capable of providing consent and for emergency situations, meeting Medicaid requirements.

Provider Guidance -Diabetes

Umpqua Health Alliance provider guidance on pharmacologic therapy for adults with type 2 diabetes, offering ADA-aligned, patient-centered strategies to support individualized diabetes management.

Provider Guidance -Hepatitis C

Umpqua Health Alliance step-wise guidance for initiating hepatitis C (HCV) treatment in primary care settings, including patient screening recommendations, testing protocols, and treatment criteria for OHP members.

Provider Guidance -Biosimilar FAQs

Umpqua Health Alliance provider FAQ on biosimilar medications, explaining what biosimilars are, how they compare to reference biologics, formulary substitution policies, and implications for OHP members.