OHP Open Card member request for rent assistance, tenancy support, utility setup, storage, and home safety modifications. Submit to ORHRSN@acentra.com.

OHP Open Card member request for home modifications — extreme weather devices (A/C, air filters), wheelchair ramps, pest control.

Verification of Landlord–Tenant Relationship and Rent Owed. Use when member has no written lease but is applying for HRSN rent and utility services.

OHA ISA Form (le-505800). Authorizes OHA to share member eligibility and information with HRSN service providers. Required before services begin.

OHP request form for nutrition benefits including medically tailored meals for members with serious health conditions requiring nutrition support.

Policy outlining the 12-hour receipt submission requirement for clients. Includes fillable signature and date fields. Sign electronically — no printing required.

Zero-tolerance fraud policy and standards all clients must follow. Includes fillable signature and date fields. Sign electronically — no printing required.

Standards of behavior expected from all clients when interacting with You Enhanced LLC staff. Includes fillable signature and date fields.

Acentra HRSN Service Eligibility Screening template (Oct 2024). Contains all required fields for eligibility and service authorization determinations.

Staff-completed form for clients who cannot provide standard income documentation. Includes verbal attestation, reason for unavailability, and fillable signature fields for staff and client.

Official policy document outlining acceptable proof of income, submission requirements, and procedures when documentation is unavailable. Reference guide for staff.

Phone: 888-834-4304
Email: ORHRSN@acentra.com
Fax: 1-833-551-2607

Portal: oregonmedicaid.us
Provider Services: 1-800-336-6016
You Enhanced NPI: 1629820071

Printable sheet of all 6 QR codes — ready for business cards, flyers, or your office wall.