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Prehospital Care Order Form

Printable Form

Thank you for using the Prehospital Care Order Form (pdf).

Please download the form, fill it out, print it and mail it to us. 

Allow 4-6 weeks to process your order.

  • All orders must be accompanied by a check or money order.
  • All orders are still on a prepaid basis.
  • Include a street address - UPS cannot deliver to a P.O. Box.
  • Make checks payable to: Oregon Health Authority - EMS
  • Mail completed form and payment to:

    Oregon Health Authority - EMS
    Business Services - 305
    P.O. Box 14260
    Portland, OR 97293-0260

If you have any questions, please email us.

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