Ronald McDonald House Oregon

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Is the patient diagnosis contagious?

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Are you a parent who is under 18 years of age?
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No   Yes
If the patient is still in utero, a fetal therapy letter from your social worker at your treating hospital is needed before your check-in date. Please indicate your social worker on this registration form and we will reach out to them for the letter. 
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Do you or anyone else who will be staying in the house have any condition that could be potentially harmful to yourself or others, including a current substance abuse disorder?
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Are you or anyone that will be staying on the National Sex Offender Registry? (Please note our staff do run all party names against this list)
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Have you or anyone in your family been convicted of or are currently facing charges for a felony or violent criminal offense?
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Are you or anyone in your family currently involved with Child Protection Services or under investigation for child abuse, neglect, domestic violence?
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Are you party to a current restraining order, protective order or no contact order?
If you need assistance making a reservation with us, click on the Request Help button in the right-hand corner above, and our Family Placement Team will call you within 24 business hours.


Name of person making this request
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Patient Information
To add additional patients, enter the information in the Additional Guests / Family Members section below and select the ‘patient’ relationship.

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Patient Preferred Name
Patient Pronouns
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For Fetal Care patients, please put the child’s expected date of delivery
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Patient address

PO Box Addresses are not accepted
U.S. / Canadian Postal Code lookup


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Patient Medicaid and OHP Information

While Ronald McDonald House does not charge a fee or ask families to pay for their stay, we do work closely with state Medicaid (Oregon Health Plan OHP, Washington, Alaska and Idaho State Medicaid) to obtain lodging reimbursement for a family's stay. This funding helps Ronald McDonald House ensure families are able to stay at no cost. If the patient is still in utero or a newborn, the parents medicaid information can be entered in.
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Reservation Information
 
You may request to check-in the day before the patient's appointment. You must check out by 12 pm the day after a patient's appointment.
If you are discharged early, you have until the next day by 12 pm to check out. (If you want to request an exception to stay longer after being discharged, please call Family Placement at 541-422-9178.)
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Ronald McDonald House will verify appointment/treatment dates with the hospital. Please enter the date/time of first appointment or hospital admittance.
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Appointment Time AM/PM (If there are multiple appointments, please enter in the 1st one)
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Healthcare Facility Contact Information:
If your child is receiving treatment at a healthcare facility not affiliated with OHSU, Doernbecher, Randall, or Legacy, please provide a contact number for someone at that facility who can verify appointment dates.

Note: Without this information, we may be unable to process your request.

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Inpatient - Hospitalized   Outpatient - Non-Hospitalized   Both, during this stay.

*Inpatient refers to Hospitalized patients. Outpatient refers to Non-Hospitalized patients.

Guardian Information

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Guardian Preferred Name
Guardian Pronouns
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I agree to receive texts at this number.
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I agree to receive texts at this number.

Second Guardian Information (Optional)

I agree to receive texts at this number.
Additional Guests / Family Members

Add Another Guest
Emergency Contact 
Please enter the name and phone number of someone who is NOT going to be staying at the Ronald McDonald House. 
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Additional Information 
Will you be parking a car with us during your stay?
¿Necesita una habitación con acceso de silla de ruedas?
Haremos todo lo posible para satisfacer su solicitud, tenemos habitaciones ADA limitadas en nuestras casas. Por favor contacte Alojamiento Familiar para confirmar el tipo de habitación después de entregar su solicitud. (541) 422-9178 o eaststay@ronaldmcdonaldhouseoregon.org.