Get Oha 0232. Authorized Representative Form

Filling out the OHA 0232. Authorized Representative Form is essential for designating an individual or organization to communicate on your behalf with the Oregon Health Authority. This guide provides detailed, step-by-step instructions to ensure a smooth completion of the form online.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section 1, indicate whether your authorized representative is an individual or an organization. If it is an individual, complete their legal name, including first, middle, last, and suffix, along with their birthdate in MM/DD/YYYY format. If your representative is an organization, enter the organization's name, the contact person's legal name (first, middle, last, and suffix), and the contact person's birthdate in MM/DD/YYYY format.
3. In section 2, provide the mailing address of the authorized representative. Fill in details such as apartment/unit number, city, state, county, and ZIP code.
4. In section 8, enter the email address for the authorized representative to ensure effective communication.
5. In section 9, specify your relationship to the authorized representative by selecting one of the provided options, such as Power of Attorney, Legal Guardianship, or Friend.
6. In section 10, print your name as the applicant before signing in section 12. Also, provide your birthdate in section 11.
7. In section 14, the authorized representative needs to print their name and sign in section 15, confirming their understanding of their responsibilities.
8. After completing all sections, review the form for accuracy. Then, save your changes, and you can choose to download, print, or share the form as needed.

Take the next step and complete your OHA 0232. Authorized Representative Form online today.