Below is a list of some of the most common forms used by members.
Click on the links to open the forms in PDF format.
- Authorization to Release Personal Health Information (PHI) Form
- YCCO Disclosure Auth – English
- YCCO Disclosure Auth – Spanish
Note: To view .pdf documents, you must have Adobe Reader installed.
Click to download the free Adobe Reader program.
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Grievance and Complaint Forms
If we don’t meet your needs, you can download a complaint form OHA 3302 Appeal and Hearing Request, or ask Customer Service staff for help filing your complaint. You also can ask your case worker for help or the Public Benefits Hotline (a program of Legal Aid Services of Oregon and the Oregon Law Center) at 1-800-520-5292, TTY Relay 711, for advice and possible representation.