Forms and Guides

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Forms

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
Member Step Therapy Appeals Form (LD-5) - English | Spanish
Self-Employment/Cash Income Statement - English | Spanish
Oklahoma Voter Registration Form
Request for Fair Hearing
Health Insurance Marketplace Application for Health Coverage
Health Insurance Marketplace Application for Health Coverage (Spanish)
Common Injury Accident Questions and Answers
IRS 1095-B Form

Other Documents

EPSDT – A Guide to Keeping Your Kids Healthy/SoonerCare Member Guide - English | Spanish
MAGI (Income Fact Sheet) - English | Spanish
SoonerCare Member Handbook - English | Spanish
SoonerPlan Family Planning Brochure

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.