AI/AN Enrollment Status Change Request

Health Authority

This government document is issued by Health Authority for use in Oregon

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File Details: PDF
Downloads: 73
Source
https://aix-xweb1p.state.or.us/es_xweb/DHSforms/Served/he0720.pdf

For American Indian/Alaska Native clients can use this form to change their current fee-for-service ("open card") or OHP health plan enrollment.

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