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Form MC5121AD County / Direct Provider Approver Certification - California
What Is Form MC5121AD?
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 MC5121AD County/Direct Provider Approver Certification?
A: The MC5121AD County/Direct Provider Approver Certification is a form used in California to certify individuals who have the authority to approve services provided by county or direct providers.
Q: Who needs to fill out the MC5121AD County/Direct Provider Approver Certification?
A: County or direct providers in California who have individuals with the authority to approve services provided by the providers need to fill out this certification form.
Q: Is the MC5121AD County/Direct Provider Approver Certification form specific to California?
A: Yes, the MC5121AD County/Direct Provider Approver Certification form is specific to California and is used to certify individuals who have the authority to approve services provided by county or direct providers in the state.
Q: What information is required on the MC5121AD County/Direct Provider Approver Certification form?
A: The MC5121AD County/Direct Provider Approver Certification form requires information such as the provider's name, contact information, and details about the individual(s) with the authority to approve services provided by the provider.
Form Details:
- Released on June 1, 2012;
- 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 fillable version of Form MC5121AD by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
