Member documents in one place
It’s important for members to have what they need recieve quality coordinated health care. If you need help with a form, please call our customer service line 1-855-722-8205!
Member Policies
Below is a list of the policies available to you as a member of YCCO.
- Care Coordination
Care Coordination Policy
Member Forms
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) - Appeal and Hearing Form
https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/me0443.pdf - Notice of Privacy Practices
- Non-Discrimination Notice (NDN)
Yamhill Community Care Non-Discrimination Notice (English)
Yamhill Community Care Non-Discrimination Notice (Spanish) - Member Rights and Responsibilities
- Advance Directives
Advance Directive (English)
Advanced Directive (Spanish) - Declaration for Mental Health Treatment
Declaration for Mental Health Treatment (English)
Declaration for Mental Health Treatment (Spanish) - Complaint Forms
Complaint Form (English)
Complaint Form (Spanish)
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