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Common Intake Form

  1. Please review the eligibility requirements (If eligible, proceed to #2)
  2. Please take the time to complete the form fully for consideration.
  3. You will need to have the participant’s SoonerCare ID and SSN
  4. If participant has a Court ordered Legal Guardian or a Court ordered Medical Decision Power of Attorney, please provide the name and contact information.
  5. Submit form using the send button or print off form and fax to 405-530-7265 for Living Choice and 405-530-7736 for Medically Fragile.
  6. All referral forms are subject to a background check with Adult Protective Services (APS) for further program consideration
  7. Allow 5-7 business days for follow-up

If you have questions or feedback, please call us at 888-287-2443 or send us an email to info@oklivingchoice.org

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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

Contact Us

The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.