Get Attachment 1 - Coordinated Care Organizations - State Of Oregon - Cco Health Oregon

This guide provides a step-by-step approach to assist users in filling out the Attachment 1 form for Coordinated Care Organizations (CCOs) online. It aims to ensure clarity and ease of understanding for all applicants, regardless of their legal background.

Follow the steps to complete the form efficiently.

1. Click the ‘Get Form’ button to obtain the application form. This can be done by selecting the option to access the form for immediate editing.
2. Begin by filling out the Applicant Information section, including the Applicant’s legal entity name, contact information, and address. Ensure all details are accurate to avoid processing delays.
3. Complete the section regarding the form of legal entity and state of domicile. This provides essential context about your organization.
4. Identify the primary contact person who will handle communications regarding the application. This person will be vital for the review process.
5. Fill in the names and titles of those authorized to represent the Applicant in negotiations. Accurate representation is crucial for contract discussions.
6. Review and acknowledge the statements regarding non-discrimination and compliance with applicable laws. Be sure to check the box certifying that all information provided is true and complete.
7. Sign the form electronically where indicated. The authorized representative must ensure that their signature is valid to avoid rejection of the application.
8. Submit the completed form. Once submitted, ensure you receive confirmation of receipt of your application for your records.

Act now to complete your application online and contribute to Oregon's health system transformation.