Get Or Msc 3970 2017-2025

The OR MSC 3970 is an essential form for personal care attendants seeking revalidation with the Oregon Medicaid system. This guide will walk you through the steps to fill out the form accurately and effectively, ensuring your submission is complete and complies with all necessary requirements.

Follow the steps to complete the OR MSC 3970 online

1. Click the ‘Get Form’ button to obtain the OR MSC 3970 and open it in your preferred online editor.
2. Begin by entering your personal care attendant information in Section I. This includes your first name, last name, date of birth, social security number, middle initial, and Oregon Medicaid ID.
3. In Section II, fill in your address information. Provide your home address (including any apartment number; do not use a PO Box), along with your city, state, and ZIP code. If your mail-to address is different from your home address, include that information as well.
4. Complete the phone number and email fields. Ensure you include the area code with your phone number and provide an email address if available.
5. Proceed to the Provider Enrollment Agreement section. Carefully read the terms and conditions, and confirm that you understand the requirements for enrollment, accurate billing, service provisions, and confidentiality.
6. In the signature field at the bottom of the form, sign and date the document to certify your agreement with the terms outlined in the Provider Enrollment Agreement.
7. After filling out all required fields, review your form for completeness. Save your changes, and if necessary, download, print, or share the document as needed.

Complete your OR MSC 3970 form online today for timely revalidation.