California Department of Health Care Services Forms

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Documents:

1049

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This form is used for creating a weekly schedule of activities in California. It helps individuals or organizations to plan and track their activities throughout the week.

This form is used for preserving personal rights in substance use disorder treatment facilities in California. It ensures that individuals receiving treatment have their rights respected and protected.

This form is used for designating administrative responsibility in the state of California.

This form is used for disclosing information to the California Department of Health Care Services (DHCS).

This document is a supplemental application form used in California to request additional services from the Department of Health Care Services.

This form is used for applying to become an initial treatment provider in California.

This Form is used for cancelling or making changes to a Medi-Cal authorized representative appointment in California.

This Form is used for organizations in California to establish a standard agreement with an authorized representative.

This form is used for individuals to appoint a representative to act on their behalf in California.

This form is used for the annual redetermination of Medi-Cal benefits in California. It is written in Spanish and is necessary to update or renew your eligibility for Medi-Cal.

This Form is used for Medi-Cal beneficiaries in California to request redetermination for long-term care in their own Medi-Cal-funded beds.

This form is used for giving consent to release confidential information in California.

This form is used for reporting any unusual incidents, injuries, or deaths that occur in California. It helps document and track such incidents for necessary action and analysis.

This form is used for authorizing the release of information in large print format in California.

This form is used for county approvers in California to certify their access to confidential mental health information.

This form is used for applying for health insurance in California, specifically designed for individuals who speak Hmong.

This Form is used for applying for the certification of social rehabilitation program services in California.

This form is used for appointing a representative for estate recovery in the state of California.

This Form is used for authorizing the release of information in California.

This form is used to appoint a representative in the state of California. It is necessary for certain legal or administrative matters.

This type of document is the Form MC355 Medi-Cal Request for Information used in California. It allows individuals to request information relating to their Medi-Cal benefits.

This form is used for appointing an authorized representative in the state of California. It allows someone to act on your behalf for specific matters, such as tax or legal issues.

This form is used for reporting confidential information on diseases and conditions to the California Department of Public Health.

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