College Support and Resources

Forms
Oregon Medical Provider Nomination Form
Survey of Charges–Periodontics
Survey of Charges–Orthodontists
Health Insurance Claim Form
Prescription Drug Claim Form
ODS Advantage PPO EFT Authorization Form
Medicare Sales Appointment Confirmation Form
Prescription Drug Claim Form
Prescription Drug Claim Form
Prescription Drug Claim Form
Multiple Pharmacy Coverage Inquiry Form
Prescription Mail Order Form
Survey of Charges–Periodontics
Moda Health Coordination of Benefits Form
ODS Advantage PPO Enrollment Form
Legacy Health Medicare Enrollment Form
ODS Medical and Dual Dental Enrollment Application
Prescription Drug Claim Form
ODS Health Plan Enrollment Application
Health Insurance Claim Form
ODS Health Plan Enrollment Application
Oregon Individual Dental Exchange Enrollment Application
Major Medical Prescription Claim Form
Medical WellConnect and Dental Enrollment Application
ODS Health Plan Enrollment Application
ODS Advantage PPO Prior Authorization Request
Coordination of Benefits Form
ODS Medical and Dental Enrollment Application
Salem Health Medicare Enrollment Form
Washington Individual Health Plan Application
Dental Procedure Fee Survey Form
ODS Portability PPO Enrollment Application
ODS Advantage PPO Enrollment Form
ODS Dental Enrollment Application Form
Provider Refund Submission Form
ODS Enrollment Application Form
Medicare Redetermination Request Form
Prescription Drug Claim Form
ODS Managed Care Enrollment Application