541-389-6313

Call for Appointment,
24/7 Nurse Advice

Locations/Hours

Find Our Clinics
in Central Oregon

541-389-6313

CALL for Appointment, 24/7 Nurse Advice

Locations/Hours

FIND Our Clinics in Central Oregon

COPA Patient Forms

Expedite your child’s care by downloading these forms to complete before you arrive. If you have any questions, please feel free to call us. 

New Patients to COPA

Release Medical Records TO COPA from another Provider

Release Medical Records FROM COPA to another Provider

OSAA Sports Physical Forms and Medical Forms 

Behavioral Healthcare Vanderbilt Forms

Payment Hardship Application

Oregon Health Plan Application Consent form 

MyHealth | MyChart E-Records Proxy Access Request

CONSENT BY PROXY | AUTHORIZATION FOR A CHILD’S MEDICAL TREATMENT
Consent by Proxy Authorization Form  
A parent or appointed guardian is required to accompany their child, 14 years or younger, to the child’s annual well-exam and for any vaccinations. The provider at those visits will inform the parent or guardian about the health of the child, discuss issues important to the patient, and in some cases COPA must receive permission from the parent or guardian to administer care.

SICK VISITS: A person who is authorized by the parent or guardian to provide consent for medical treatment may accompany the child for sick visit only, however, the following form must be completed and delivered to COPA for the visit or treatment to occur: Consent by Proxy Authorization Form  

APPLY FOR OREGON HEALTH PLAN
COPA is able to assist you with your application for Oregon Health Plan. Please complete this document to finalize your enrollment. Oregon Health Authority Consent form for OHP Application.

FORMULARIOS EN ESPANOL
Bienvenido a COPA

Autorizacion Para Solicitar Registros Medicos De Fuera

Transferir los Registros de la COPA

OHA Consentimiento [Oregon Health Plan-OHP]

CONSENTIMIENTO DE PROXY PARA EL TRATAMIENTO MÉDICO | Se requiere que un padre o tutor designado acompañe a su hijo, de 14 años o menos, al examen de bienestar anual del niño y para cualquier vacuna. El proveedor informará al padre o tutor acerca de la salud del niño, discutirá temas importantes para el paciente y, en algunos casos, COPA debe recibir permiso para administrar la atención. Una persona autorizada por el padre o tutor para proporcionar el consentimiento para el tratamiento médico puede acompañar al niño para una visita por enfermedad solamente, sin embargo, el siguiente formulario debe completarse y entregarse a COPA para que se realice el tratamiento.  Autorizacion Por Consentimento Del Representante

PRIVACY POLICIES

Featured Physician

DR. MEGAN KARNOPP

MD, FAAP
Board Certified Pediatrician

Meet the Doctor

Voted Best, Most Recommended Pediatricians in Bend and Redmond, Oregon

©2018 Central Oregon Pediatric Associates | COPA is a 5-Star medical home for kids and the region's largest provider of pediatric health care for children, serving newborns through high school.
Open 7 days a week with four locations in Bend and Redmond, extended hours and 24/7 Nurse Advice.

WEBSITE PRIVACY STATEMENT: 

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