Ronald McDonald House Charities of Oregon & Southwest Washington

Update: This form is only for OHSU South Waterfront house. If you would like to request to stay at the East House at Randall Children's Hospital. Please use the new family referral form or the returning family referral form. 

Notifications

  • Reservation requests may be submitted no more than 30 days ahead of your check-in date.
  • 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 971-230-6702.)
  • All guests 18+ must be prepared to present photo ID upon arrival at the House.
  • All guests 18+ will be screened against the National Sex Offender Registry.
  • All guests must be free of contagious illness before arrival.
  • Rooms allow 6 People max per family. Children under 24 months do not count towards the total. 
  • Only 1 room per family is allowed. 

    To qualify to stay, the following criteria must be met:

  • The patient is 21 or younger.
  • At East House in Portland, the patient and guardian must live 30 or more miles from the facility where they are receiving care. (Portland only)
  • At South Waterfront House in Portland, the patient and guardian must live 50 or more miles from the facility where they are receiving care. (Portland only)
  • The patient is either admitted to the hospital or has medical appointments no more than 48 hours apart.
  • The family can function independently in our community living environments.

Screening Questions 

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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 Preferred 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 Charities RMHC 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 RMHC 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 971-230-6702.)
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RMHC 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 Preferred 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 
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Will you be parking a car with us during your stay?
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No   Yes
Does the family require an ADA Room?
We will do our best to accommodate, but this is not guaranteed. Please reach out to family placement to check on availability after you submit your request. Family@rmhcoregon.org.
If OHSU South Waterfront House is full, would you like to be considered for a room at our East House located at 2620 N Commercial Ave? This location is a 15 min drive from OHSU.