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Form MC381 Cancellation or Change to a Medi-Cal Authorized Representative Appointment - California
What Is Form MC381?
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 Form MC381?
A: Form MC381 is used to request a cancellation or change to a Medi-Cal Authorized Representative Appointment in California.
Q: Who can use Form MC381?
A: This form can be used by individuals who wish to cancel or make changes to their authorized representative appointment for Medi-Cal benefits in California.
Q: What information is required on Form MC381?
A: Form MC381 requires the individual's personal information, the name and contact information of the authorized representative, and the reason for cancellation or change.
Q: How do I submit Form MC381?
A: You can submit Form MC381 by mail or fax to your local county office. Make sure to follow the instructions provided on the form.
Form Details:
- Released on June 1, 2018;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Arabic;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form MC381 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
