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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 DHCS9113
for the current year.
Form DHCS9113 Appointment of Representative - California
What Is Form DHCS9113?
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 DHCS9113?
A: DHCS9113 is the form used in California to appoint a representative for a person receiving services from the Department of Health Care Services.
Q: Who needs to fill out DHCS9113?
A: DHCS9113 needs to be filled out by a person who wants to designate someone to act on their behalf for matters related to their health care services in California.
Q: What does DHCS9113 allow the representative to do?
A: DHCS9113 allows the designated representative to make decisions and act on behalf of the person receiving health care services in California.
Q: Is there a deadline to submit DHCS9113?
A: There is no specific deadline to submit DHCS9113, but it is recommended to complete and submit the form as soon as possible to ensure timely representation.
Q: Can I update or change my representative after submitting DHCS9113?
A: Yes, you can update or change your representative by completing a new DHCS9113 form and submitting it to the Department of Health Care Services.
Q: Are there any fees associated with submitting DHCS9113?
A: No, there are no fees associated with submitting DHCS9113 or appointing a representative for health care services in California.
Form Details:
- Released on September 1, 2015;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form DHCS9113 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
