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  • Ohca Fax Number Form

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Ity Name Address FACILITY PROVIDER NUMBER DHS Case Number PRIOR LIVING ARRANGEMENT: ICF/MR Relative s Home Asst. Living Res Care COUNTY RACE Date of Birth Hisp Y Gender N M City RID NUMBER DISCHARGE OHCA USE ONLY Level II Required: Yes No Coverage F State Zip Level II Completed Date New Admit/Inter-facility Transfer/Name of Transferring Facility Own Home Mental Hospital (MD) Hospital SNF Other NF (ICF) Group Home DHS USE ONLY Nurse Signature: I agree DECEASED Date Reviewe.

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Contact support

Pharmacy PA Requests should be faxed to: OKC Metro (405)271-4014 or Toll-Free (800)224-4014.

If you are applying for SoonerCare for the first time, you must provide one-time proof of your U.S. citizenship and identity. This flyer explains how to send in that proof. Newborn children (under age one) of SoonerCare members do not have to show proof.

How long does it take to process an enrollment application? A. OHCA should complete the enrollment process within four (4) weeks from the receipt of a completed enrollment application, including all required documents.

For assistance with the Online SoonerCare Application or other questions or concerns about SoonerCare, please call the SoonerCare Helpline at 800-987-7767.

Authorization Unit (MCAU), approves or disapproves each medication authorization request on behalf of the OHCA. The MCAU staff can be reached by phone at 405-522-6205 option 4 / 800-522-0114 option 4 or by fax at 405-271-4014 / 800-224-4014.

WHAT IS SOONERCARE? SoonerCare is the brand name given to Oklahoma's Medicaid program. Medicaid is a program that covers medical expenses for certain groups of people who have limited income and resources. The Oklahoma Health Care Authority is the state agency that administers the program.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232