Community Advisory Council - Application Form

Apply now: Health Related Social Needs Community Capacity Building Funding is available.

Columbia Pacific CCO Community Advisory Council

Membership interest form

Are you interested in making a difference in your own health care? Are you, or a member of your family, enrolled in Oregon Health Plan? Would you like to join our conversation? Columbia Pacific Coordinated Care Organization has Community Advisory Councils (CAC) in each county and is currently looking for members. The goal of the CACs is to inform the CCO on how to best meet the needs of members enrolled in the Oregon Health Plan, as well as the whole community. The CAC’s are made up of plan members, and community representatives who want to make a difference in how their health plan operates. Members selected to serve on the CAC will reflect a diversity of people, skills, and backgrounds in order to best serve the members and communities of Columbia Pacific.

The Community Advisory Council will help Columbia Pacific CCO:

• Meet the health care needs of Oregon Health Plan members and the community
• Identify and advocate for preventive care services
• Oversee the Community Health Needs Assessment
• Provide feedback on the Community Health Improvement Plan (CHIP)
• Evaluate services provided by Oregon Health Plan and Columbia Pacific CCO
• Help the CCO clearly communicate with Oregon Health Plan members and others

If you have any questions, please contact us at caccoordinator@colpachealth.org

Please provide the following information and a CAC Coordinator will contact you:

Name * First Last
Email *
Phone Number * ### - ### - ####
Best Time to Call *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Check All That Apply *
I am enrolled in the Oregon Health Plan. I am a family member of someone enrolled in the Oregon Health Plan. I work closely with people enrolled in the Oregon Health Plan. I reside in a community served by Columbia Pacific CCO (Clatsop, Columbia, or Tillamook counties).
Digital Signature:
By typing your name below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By signing this you acknowledge that your statements on this form are true. *
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