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Department of Consumer & Business Services Insurance Division 2 P.O. Box 14480 Salem, Oregon 973090405 Phone: (503) 9477269 Fax: (503) 3784351 350 Winter St. NE, Rm. 440, Salem, Oregon www.oregoninsurance.org
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To fill out the UnitedHealthcare of Oregon form, follow these steps:
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Start by entering your personal information, such as your name, address, and contact details.
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Provide your social security number and date of birth for identification purposes.
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Specify the type of coverage you are applying for, such as individual, family, or group plan.
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Answer the questions regarding your current healthcare coverage, if any.
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Indicate any pre-existing medical conditions you may have.
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Provide information about your primary care physician or healthcare provider.
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Sign and date the form to certify that the information provided is accurate and complete.
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Submit the filled-out form as per the instructions provided by UnitedHealthcare of Oregon.

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