PPE Order Form

Contact Information

The Oregon Home Care Commission (OHCC) has PPE available for providers who require it to safely support their consumer-employers' service needs. Monthly PPE supplies can be ordered every 30 days (or as needed) by completing this request.

For immediate needs, contact your local office where gloves and masks are available until your OHCC order arrives.

1. Provider Number *This question is required.

2. Last Name *This question is required.

3. First Name *This question is required.

4. Email Address *This question is required. This question requires a valid email address.

5. Mailing Address *This question is required.

6. City *This question is required.

7. State *This question is required.

8. Zip Code *This question is required.