EOCCO primary care provider change form

PCP change form

Use this form to update your Primary Care Provider (PCP). If you are a member residing in Morrow or Umatilla county, please call 503-765-3521 or fax a physical form to 541-278-8895 to update your PCP.

Before changing your PCP, please review the following steps:

  1. Use Find Care, our provider search tool, in order to verify your new PCP is in-network.
  2. Contact your new PCP to verify they are accepting new patients, some offices do not.
  3. Remember your new PCP is effective at the beginning of the next month.
  4. Also note that you may only change your PCP twice every six months.

Request

Member info

Please enter the subscriber's full name.
Please enter the subscriber's ID number.
Please enter the subscriber's birthdate.
Please enter the subscriber's email address.
Please enter the subscriber's phone number.

PCP info

Please enter the PCP's full name.