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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHCS9120
for the current year.
Form DHCS9120 Statement of Diagnosis Medical Report - California
What Is Form DHCS9120?
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 DHCS9120 Statement of Diagnosis Medical Report?
A: The DHCS9120 Statement of Diagnosis Medical Report is a form used in California to provide medical information and diagnosis for a patient.
Q: Who uses the DHCS9120 Statement of Diagnosis Medical Report?
A: The DHCS9120 Statement of Diagnosis Medical Report is used by healthcare providers, medical professionals, and insurance companies in California.
Q: What information is included in the DHCS9120 form?
A: The DHCS9120 form includes patient identification information, medical history, diagnosis, treatment information, and the provider's contact details.
Q: Why is the DHCS9120 form important?
A: The DHCS9120 form is important for providing accurate and comprehensive medical information for insurance claims, disability assessments, and medical record keeping.
Form Details:
- Released on March 1, 2011;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DHCS9120 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form DHCS9120 Statement of Diagnosis Medical Report - California
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