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Form MC0021 Medi-Cal to Healthy Families Bridging Consent Form - California
What Is Form MC0021?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the MC0021 Medi-Cal to Healthy Families Bridging Consent Form?
A: The MC0021 form is used in California to request consent to transfer from Medi-Cal to the Healthy Families program.
Q: Who can use the MC0021 form?
A: The MC0021 form can be used by individuals who are currently enrolled in Medi-Cal and wish to switch to the Healthy Families program.
Q: What is the purpose of the MC0021 form?
A: The purpose of the MC0021 form is to obtain consent from the Medi-Cal recipient to transfer their coverage to the Healthy Families program.
Q: What information is required on the MC0021 form?
A: The MC0021 form requires the individual's name, date of birth, Medi-Cal identification number, and signature to provide consent for the transfer.
Form Details:
- Released on April 1, 2017;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Armenian;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form MC0021 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
