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Provider Resources

The committees of the 100% Access Initiative have developed the following resources to help healthcare and human service providers who work with uninsured indivduals.

In its commitment to developing a system of care for the uninsured, the 100% Access Initiative is working to identify existing resources across Lane County, coordinate those programs and services, and then help connect uninsured indivduals to the care they need.

Medical Access Program

Charitable Immunity Waiver Forms
State of Oregon Board of Medical Examiner's Charitable Immunity Waiver request forms and related statutes for providers

MAP MIS User Registration
User name and password request form

Provider Sign up Form
Provider Sign Up Form to accept Medical Access Program patients

Medications Price Lists and Brochures

Community Pharmacy Brochure
Brochure for providers to give to patients explaining some of the available assistance in Lane County. (two-sided, tri-fold)

Free and Low-Cost Medications by Alpha
Compiled price list of free and low-cost drugs alphabetized by drug name. Last revised April 2008.

Free and Low-Cost Medications by Class
Compiled price list of free and low-cost medications by drug class. Last revised April 2008.

Healthcare and Mental Health Referral Cards

Healthcare safety net clinics and dental referral cards
Most current version August 2007 of healthcare safety net clinics and dental referral cards.

Mental health referral services
Most current version of mental health referral resources for adults and children.

Living Well -- Chronic Disease Self Management Classes

Flyer for upcoming group leader training
There is a group leader training scheduled for January 2009. Participants must attend the full four days.

Call 687-6200 for more information and to register.

Information From the OHP and Community Resource Training Nov 2008

2008 Federal Poverty Level Guidlines
2008 Federal Poverty Level broken down into hourly wage, monthly and annual Pay

Authorization for use and Disclosure
Release of information form

Authorization for use and Disclosure in Spanish
Release of information form in Spanish

Birth Certificate
Guidelines for getting a Birth Certificate

Citizenship and Identity Documentation
Full list of acceptable primary and secondary documents to prove citizenship, documentation and identity

Contact Phone Numbers
DHS District 5 Contact Numbers for 100% ACCESS Outreach

DHS Offices in Lane County
Directory of DHS offices, and who they serve

DHS Presentation
DHS PowerPoint from Training

DHS Programs in Lane County
List of different programs that are available in Lane County

Gateway Service Delivery
Adresses that go to Gateway DHS for services

Healthcare Acronyms
List of acronyms for healthcare programs, and state agencies and programs.

Identity Affidavit in English and Spanish
Form used to claim children under age 16

Missing Information Form, in English and Spanish
A reminder to clients of what information they still need to complete OHP application

Need an Oregon Identification or Social Security Card?
Contact information for Lane County DMV's, and how to obtain a social security card

New Medical Card Description
Information on the new DHS medical card system

Prescription Assistance Brochure