CareOregon HRSF Digital Request Form

Please use this form for any Health Related Services Flex Requests (HRSF) that are not for housing, climate, or nutrition related needs. Any requests for those specific needs must be submitted through the HRSN benefit request form. Please find the HRSN request forms linked below: 

If you are in need of an air conditioner, air purifier, heater, medication refrigerator, or power pack for certain medical devices, please submit a request using the Climate Device Request Form.

If you are in need of rent or utilities support, home modifications or remediations, or hotel stays if you are unable to remain in your home during approved home remediations/modifications, or storage fees, please submit a request using the Housing Request Form. If you are requesting a hotel/motel stay, please review and attest to the member code of conduct form on page 10.

If you are in need of an assessment for medically tailored meals or medically tailored meals, or nutrition education, please submit a request using the Nutrition Request Form.

Not all requested items or services are granted/funded. CareOregon evaluates each request on a case-by-case basis and makes the final funding determination. Please review the Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.

More information is available on the CareOregon Social Needs Assistance Webpage.