OHP Referral Form for Portland Public Schools

This is the Community Partner Outreach Program (CPOP) referral form to serve Portland Public Schools students/ families who are seeking Oregon Health Plan (OHP) assistance. To submit a referral to an OHP Certified Organization outside PPS, please refer to the Find Local Help page: https://healthcare.oregon.gov/Pages/find-help.aspx


IMPORTANT: Response time will be within 2-4 business days. If this is an emergency, please go to the nearest emergency room or call 911. Call 988 and press 1 for any mental health crisis.


Thank you for your patience.

Referrer Information


Name

Phone
3. Consent to release Referred Individual Information obtained by PPS?*
4. Urgency Level*

Client Information

5. Who is the Referred Individual?*

Preferred method of communication:

Phone
Phone
7. What are the OHP needs of the Referred Individual?*

We cannot accept referrals without consent to release Referred Individual Information obtained by PPS. You may now close this form.

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