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HEALTH LICENSING OFFICE Long Term Care Administrators Board 1430 Tandem Ave. NE, Suite 180, Salem, OR 973012192 Phone: 5033788667 Fax: 5033709004 www.healthoregon.org/hlo Email: HBO.info state.or.sprint
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To fill out the Oregon Health Licensing Agency long form, follow these steps:
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Begin by entering your personal information, such as your name, address, and contact details.
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Provide details about your current license or certification, including the type of license, license number, and expiration date.
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Indicate the specific services you are licensed to provide and any additional endorsements or specialties you may have.
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Fill out the section related to your education and training, including details about your degree or certification program.
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If applicable, provide information about any previous licenses held in other states or countries.
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Submit the filled-out form to the Oregon Health Licensing Agency according to the instructions provided.

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The Oregon Health Licensing Agency, or OHLA, is a state agency responsible for licensing and regulating health care professionals in Oregon.
Health care professionals in Oregon are required to file with the Oregon Health Licensing Agency.
Health care professionals can fill out the Oregon Health Licensing Agency form online through the agency's website or by submitting a paper form by mail.
The purpose of the Oregon Health Licensing Agency form is to ensure that health care professionals meet the state's licensing requirements and maintain compliance with regulations.
Health care professionals must report their personal information, professional qualifications, and any disciplinary actions or criminal history.
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