Form MC4035 Medi-Cal Consent Form - California (Vietnamese)

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.

The document is provided in Vietnamese. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the MC4035 Medi-Cal Consent Form?
A: The MC4035 Medi-Cal Consent Form is a document used in California to obtain consent from individuals for the release and use of their personal information for the purposes of administering Medi-Cal benefits.

Q: Who needs to fill out the MC4035 Medi-Cal Consent Form?
A: Individuals who are applying for or already receiving Medi-Cal benefits in California may need to fill out the MC4035 Medi-Cal Consent Form.

Q: What information is gathered on the MC4035 Medi-Cal Consent Form?
A: The MC4035 Medi-Cal Consent Form collects personal information such as name, address, date of birth, social security number, and Medi-Cal identification number.

Q: How is the MC4035 Medi-Cal Consent Form used?
A: The MC4035 Medi-Cal Consent Form is used to grant permission for the release and use of personal information for the purposes of determining eligibility, enrolling in Medi-Cal, monitoring program compliance, and requesting and verifying payment for services.

Q: Is the MC4035 Medi-Cal Consent Form available in Vietnamese?
A: Yes, the MC4035 Medi-Cal Consent Form is available in Vietnamese for individuals who prefer to fill it out in that language.