Forms

Form number	Title
CH-1	Week Old Visit
CH-2	1 Month Visit
CH-3	2 Month Visit
CH-4	4 Month Visit
CH-5	6 Month Visit
CH-6	9 Month Visit
CH-7	12 Month Visit
CH-8	15 Month Visit
CH-9	18 Month Visit
CH-10	24 Month Visit
CH-11	30 Month Visit
CH-12	3 Year Old Visit
CH-13	4 Year Old Visit
CH-14	5 Year Old Visit
CH-15	6 to 10 Year Old Visit
CH-16	11 to 20 Year Old Visit

Last Modified on Nov 17, 2020

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.