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Oregon Health Plan Forms

To improve coordination of care between PCPs and Mental Health Providers for Southern Oregon residents, the Mind Body Connection (MBC) collaborative was established in 2005. MBC created a Notice of Referral/Consent For the Release of Information form for OHP members. This form exists to enhance communication of vital information between mental and physical health care providers via a legal release of information signed by the patient, parent or legal guardian. ODS partners with Family Care and Mid Rogue Health Plan to distribute this tool to providers in Jackson County. Please use this new form with all OHP patients in Jackson County. You may download the form and checklist using the links below.

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