Forms
The following CareMark Comp MCO Precertification Forms are now available in fillable .pdf format which allow users to FILL-IN the
necessary information by computer and PRINT ONLY.These forms cannot be e-mailed or submitted through the MHN website. These forms can also be printed and completed by hand and then faxed as well.
As always, we require completed precertification forms to be faxed withall the required supporting information to: (503) 413-5864.
Please note: Adobe Acrobat Reader is required for these documents. Click here
for the latest version of Adobe Reader.
CareMark Comp MCO:
- Precertification Form for Chiropractic, Osteopathic Manipulation, PT, OT (functional), and Hand Therapy
- Click here for instructions on the form above.
- Precertification Form for Acupuncture, Massage, Speech-Lang Pathology, OT (cognitive), Vision Therapy, Pain Program and Work Hardening
- Click here for instructions on the form above.
SPECIAL FORMS FOR:
City of Portland Fire and Police Disability and Retirement Fund (FPDR)
Attending Physicians Report (APR)
Other Forms
Physician Additional Information Form (.pdf)
Oregon Practitioner Credentialing Application (.pdf)
Oregon Practitioner Credentialing Application (.doc)