Health Care Interpreters’ Certification Program OHA 8901 ...



|DIRECTOR’S OFFICE, Office of Equity and Inclusion |[pic] |

|Oregon Health Care Interpreter Program | |

| | |

Oregon Health Care Interpreter Registry Application Instructions

The Health Care Interpreter Registry is a database of working health care interpreters in Oregon. The registry includes three types of interpreters:

• Those who have met only the requirements for registration;

• Qualified health care interpreters; and

• Certified health care interpreters.

Note/disclaimer: Enrolling in the Oregon Health Care Interpreter Registry does not confer qualified or certified health care interpreter status. The state makes no claims as to the competence of registered health care interpreters who are not qualified or certified.

Requirements for enrollment in the Oregon Health Care Interpreter Registry:

• At least 18 years of age;

• High school diploma or GED from an accredited school in the United States of America

or an equivalent diploma from another country;

• Fluent in English and another language; and

• Review online orientation materials and agree to abide by National Standards of Practice and Code of Ethics for Health Care Interpreters.

Application types and fee: (Indicate type you are applying for on page 2.)

• Registration only. Enroll in the Oregon Health Care Interpreter Registry only without applying for qualification or certification. Fee: $25.00.

• Registration and qualification. Enroll in the Health Care Interpreter Registry as part of an application for qualification. Fee: $25.00.

• Registration and certification. Enroll in the Health Care Interpreter Registry as part of an application for certification. Fee: $30.00.

• Renewal of qualification or certification. Update registry information as part of an application to renew your qualification or certification. Provide your current registry number on page 2 of the application. Fee: $25.00.

• Registry information update. Provide your current registry number on page 2 of the application. No fee.

Questions? Feel free to contact us at: hci.program@state.or.us, call 971-673-1286 or

go to interpreters..

|This document can be provided upon request in alternative formats for individuals with disabilities or in a language other than English for people with|

|limited English skills. To request this form in another format or language, contact Oregon Health Care Interpreter program at 971-673-1286 or |

|hci.program@state.or.us or 711 for TTY} |

The Oregon Health Authority (OHA) do not discriminate against anyone. This means that OHA will help all who qualify and will not treat anyone differently because of age, race, color, national origin, gender, religion, political beliefs, disability or sexual orientation.

You may file a complaint if you believe OHA treated you differently for any of these reasons.

To file a complaint with the state, you can call the Governor’s Advocacy Office at

1-800-442-5238 (TTY 711), fax: 503-378-6532, email: @state.or.us or write to their office at:

Governor’s Advocacy Office

500 Summer Street NE, E17

Salem, OR 97301

“Equal opportunity is the law!”

|DIRECTOR’S OFFICE, Office of Equity and Inclusion |[pic] |

|Oregon Health Care Interpreter Program | |

| | |

|Health Care Interpreter Registry Application |OHA use only |

| | |

| |70400/72420-2180 |

|Name: |      |      |      |

| |Last |First |Middle |

|Address: |      |      |      |      |

| |Street |City |State |ZIP |

|Mailing address: |      |      |      |      |

| |Street |City |State |ZIP |

|Phone number(s): Home: |    -     -       |Alternate: |    -     -       |Email: |      |

|Date of birth (mm/dd/yyyy): |   /    /      | |

Language(s) in which you are fluent, including English.

| African languages (specify): | Italian | Slavic (specify |

| |      | Japanese | |      |

| Arabic | Korean | Spanish |

| Bosnian | Lao/Laotian | Somali |

| Burmese | Mandarin | Tagalog |

| Cantonese | Marshallese | Teochew |

| English | Mien | Thai |

| Farsi | Mon-Khmer, Cambodian | Urdu |

| French | Persian | Vietnamese |

| German | Romanian | Sign language (specify): |

| Hindi | Russian | |      |

| Hmong | Scandinavian (specify): | Other (specify): |

| Indic (specify): | |      | |      |

| |      | | |

Geographic availability − Where are you willing to work? Choose as many locations as desired.

|Region 1 |Region 2 |

| Sunday Wednesday Friday | Day 7:00 a.m. – 5:00 p.m. |

|Monday Thursday Saturday |Evening 5:00 p.m. – 12:00 a.m. |

|Tuesday |Night 12:00 a.m. – 7:00 a.m. |

|Are you available as an interpreter to potential employers? Yes No |

Note: Information you provide above will be publicly available on the Health Care Interpreter Registry, unless you

request otherwise. Check here if you would like your contact information kept confidential.

Voluntary demographic information

If you choose to provide the following information, it will be used for statistical purposes only. (Choose all that apply.)

|Gender: |Race: |

| Female | American Indian/Alaska Native Native Hawaiian/other Pacific Islander |

|Male |Asian White/Caucasian |

| |Black/African-American Declined to answer |

| | 2 or more races Other: |      |

| |

|Ethnicity: Hispanic or Latino Not Hispanic or Latino Declined to answer |

Verifications and commitments:

• I am at least 18 years of age;

• I am fluent in English and another language;

• I have completed a high school diploma or GED from an accredited school in the USA, or an equivalent diploma

from another country;

• I have read the following orientation materials (available from the Oregon Health Care Interpreter Program at interpreters.):

• National Standards of Practice for Interpreters in Health Care

• National Code of Ethics for Interpreters in Health Care

• Health Care Interpreting Law ORS 413.550

• Oregon Administrative Rules OAR 333.002

• I understand that any action beyond these guidelines is a violation of these ethics and standards of practice; and

• I agree to practice within the guidelines of the National Standards of Practice and National Code of Ethics for Interpreters in Health Care.

By signing below, I certify that the above verifications and commitments, as well as all other information contained in this application, are true and accurate to the best of my knowledge and understanding.

|Name (print): |      |

|Signature: | |Date: |      |

Notes to applicant

If you are enrolling in the Health Care Interpreter Registry as part of an application for qualification or certification, attach additional documentation as needed. Go to interpreters. for details.

Please notify the Oregon Health Authority (OHA), Office of Equity and Inclusion (OEI) of any changes in your

registry information.

Application type (choose all that apply):

| Registration only. Fee $25.00. |

|Registration and qualification. Fee $25.00. |

|Registration and certification. Fee $30.00. |

| Renewal of qualification or certification, Registry no.: |      |. Fee $25.00. |

| Registry information update, Registry no.: |      |. No fee. |

Make check payable to: OHA/OEI Health Care Interpreter Program

This application must be signed and mailed with the application fee to:

Oregon Health Authority/Office of Equity and Inclusion

Health Care Interpreter Program

800 NE Oregon Street, Suite 550

Portland, OR 97232

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