You may name a relative, friend, lawyer, advocate, doctor or anyone else to act for you. Other persons may already be authorized by the court or in accordance with state law to act for you. If you want someone to act for you who is not already authorized by the court or under state law, then you and that person must sign and date a statement that gives the person legal permission to be your representative. To learn how to name your representative, you may call Customer Service. If you wish to appoint a representative, you may download, fill out and forward this form to the following location:

FamilyCare Health Plans
ATTN: Customer Service
825 NE Multnomah, Suite 300
Portland, OR 97232