Samaritan Select

Health risk assessment

You can help your doctor and Samaritan Select by answering questions about your health using our Health Information Form [For Adults Age 20 and Over] [For Children]. This assessment is part of the Samaritan Select vision for providing you with an integrated system of care. The information you provide will help us know how we can best meet all of your health care needs.

All information given in this form will be kept confidential and will not affect your benefits in any way. Completion of a health information form is optional, but encouraged. If you have already completed a form as part of your enrollment package, it is not necessary to do so again.

If indicated by your HRA, a Samaritan Select nurse will contact you as part of our Nurse Case Management programs. These programs help members to effectively manage their diseases or conditions so they can lead healthy, active lives by bringing providers together for an interdisciplinary, clinical team approach to deal with complex medical needs.

Completed forms should be mailed to:

Samaritan Select
Samaritan Health Plans
P.O. Box 1310
Corvallis, OR 97339

If you have any questions, please contact us at (541) 768-6900 or toll free at 1-800-569-4616, Monday through Friday, 8 a.m. to 5 p.m.