We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Or Pacificsource Care Coordination Request Form 2016

Get Or Pacificsource Care Coordination Request Form 2016-2025

Ment under PacificSource coverage. We understand your concern and will contact you (or your designee) to discuss your ongoing care needs. Please complete all applicable sections below, and return the form as soon as possible to: PacificSource Health Plans ATTN: Health Services Dept. PO Box 7068 Springfield, OR 97475-0068 Fax (541) 225-3625 If you have questions, please call Health Services at (541) 684-5584, or toll-free at (888) 691-8209 Employer/Group Name Date PacificSource coverage will be.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Coordinated Care Organizations (CCO) : Oregon...
Find contact information for Oregon's coordinated care organizations (the local health...
Learn more
Forms, Policies and Resources
Release of Information form (outgoing) - to request Student Health records to be sent to...
Learn more
REQUEST FOR PROPOSAL
Sep 14, 2016 — The Purpose and Intent of this Request for Proposal (RFP) is to establish...
Learn more

Related links form

GA Bar Unlicensed Practice Of Law Complaint Form 2017 OR Instructions For Filing Small Estate Affidavit 2020 LA Lease Termination Letter HI 5-Day Notice To Pay Rent Or Quit The Premises 2016

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Please Send All Claims to: PacificSource Health Plans Attn: Claims Department PO Box 7068 Springfield OR 97475-0068.

You may contact the Health Services team by phone at 888-691-8209 or by fax: 541-225-3625.

The PacificSource brand includes PacificSource Health Plans, PacificSource Community Solutions, PacificSource Administrators Inc., and IPN. Individual health insurance, Medicare Advantage, Medicaid, group health, dental, vision, and prescription coverage, are available to residents of the Northwest.

In Oregon, Medicaid is called the Oregon Health Plan, or “OHP,” and is run by the Oregon Health Authority. In specific regions in Oregon, PacificSource Community Solutions coordinates your care and manages your OHP benefits.

Birth control and contraceptives Your first prescription can be up to a 3-month supply. After that, you can receive a year's supply of the same prescription.

Email: CS@PacificSource.com. Fax: Mail: PacificSource Health Plans, PO Box 7068, Springfield, OR 97475-0068.

In Oregon, Medicaid is called the Oregon Health Plan, or “OHP,” and is run by the Oregon Health Authority. In specific regions in Oregon, PacificSource Community Solutions coordinates your care and manages your OHP benefits.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get OR PacificSource Care Coordination Request Form
Get form
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
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