Umpqua Health Providers

Documents & Forms

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

Social Determinants of Health (SDoH) Reporting Guidance

This document provides guidance for clinical partners on reporting social needs screenings and referrals, outlining four submission options and required data elements for housing, food, and transportation.

Social Determinants of Health (SDoH) 2025 Gap Analysis

This document presents a detailed gap analysis of Douglas County, comparing Medicaid data, UHA HRA results, claims, and Unite Us data, with stratification by REALD identifiers.

Cow Creek Cooking Demonstration Flyer 2026 – English

Flyer for a free January 2026 cooking demonstration class at the Healthy Teaching Kitchen in Roseburg featuring ‘Nourish Bowls: A simple, tasty, and fiber-rich approach to meal prep,’ hosted by the Cow Creek Health and Wellness Healthy Living Team. Wednesday, January 28, 2–3:30 PM. Registration required: (541) 672-8533.

Cow Creek Grocery Shopping Tour Flyer 2026 – English

Flyer for a free Cow Creek Grocery Shopping Tour led by the Healthy Living Team on January 28, 4–5 PM at Sherm’s Thunderbird Market in Roseburg, teaching Umpqua Health members dietitian-recommended strategies for healthy, budget-friendly grocery shopping. Contact: (541) 672-8533, option #2.

Diabetes Prevention Program 2026 –  English

Flyer for the Cow Creek Diabetes Prevention Program launching January 15 at the Cow Creek Health and Wellness Center South Clinic in Canyonville, a scientifically proven group-based program led by Certified Lifestyle Coaches covering nutrition, cooking demonstrations, and lifestyle strategies to prevent type 2 diabetes. Sign up: (541) 672-8533.

Food as Medicine UCVEG Lifestyle Nutrition Course – English

Flyer for the UC VEG Lifestyle & Nutrition Course through Food As Medicine Oregon, a community program teaching plant-based nutrition strategies to help prevent and reverse chronic conditions including diabetes, heart disease, and obesity. Register at FoodAsMedicineOregon.org or call 541-378-6359.

Movement is Medicine Walking Group Flyer 2026 -English

Flyer for the Cow Creek Health and Wellness Walking Group meeting every 2nd and 4th Tuesday from 9–10 AM at Millsite Park in Myrtle Creek, offering Umpqua Health members a guided walk with a Registered Dietitian to improve health, build community, and connect with nature. Contact Claire Grubb, RD: (541) 672-8533 ext. 5266.

THW Cervical Cancer Prevention Training Flyer – English

Flyer announcing a continuing education training on eliminating cervical cancer, offered to Traditional Health Workers and providers in partnership with the South Coast Community Cancer Control Specialist, with 2 CME hours available.

HRSN MTM Assessment Referral Form

This form can be used by PCPs and Registered Dieticians to complete the required assessment for members seeking HRSN Medically Tailored Meals (MTM).

HRSN MTM Benefit Overview

This guide provides an overview of the HRSN Medically Tailored Meals benefit for clinics and providers who may have patients with eligible conditions.

Potential Quality of Care (PQOC) Referral Form

Potential Quality of Care (PQOC) Referral Form used to submit concerns for review and investigation when a potential quality-of-care issue has been identified.

Quality Pool Distribution Plan

UHA’s distribution plan for its Quality Pool and Challenge Pool earnings. The purpose of the plan is to inform UHA’s Participating Providers, including Social Determinants of Health and Equity (SDOH-E) and public health partners, about UHA strategies and processes for distribution of Quality Pool funds.