Forms and Instructions

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Authorization to Release Medicaid Records
Autorización para revelar registros de Medicaid
End of Life Legal Forms | Testamento Vital Formulario Legal
Member Complaint/Grievance Form (LD-1) English | Spanish
Request for Telephonic Hearing (LD-4) English | Spanish
Member Step Therapy Appeals Form (LD-5) English | Spanish
Self-Employment/Cash Income Statement English | Spanish

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.