Form DHCS5020 Guarantor Agreement - California

Form DHCS5020 Guarantor Agreement - California

What Is Form DHCS5020?

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 DHCS5020 Guarantor Agreement?
A: The DHCS5020 Guarantor Agreement is a form used in California to establish a person as a guarantor for the medical care and treatment of a patient.

Q: Who needs to fill out the DHCS5020 Guarantor Agreement?
A: The DHCS5020 Guarantor Agreement should be filled out by someone who is willing to take responsibility for the payment of medical expenses for a patient.

Q: Is the DHCS5020 Guarantor Agreement legally binding?
A: Yes, the DHCS5020 Guarantor Agreement is a legally binding agreement between the guarantor and the healthcare provider.

Q: What are the responsibilities of a guarantor under the DHCS5020 Guarantor Agreement?
A: The guarantor is responsible for paying any outstanding medical expenses not covered by insurance for the patient.

Q: Can a guarantor be held responsible for someone else's medical bills?
A: Yes, the guarantor agrees to be financially responsible for the patient's medical expenses, even if they are not the patient themselves.

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Form Details:

  • Released on March 1, 2017;
  • 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 DHCS5020 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.

Download Form DHCS5020 Guarantor Agreement - California

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  • Form DHCS5020 Guarantor Agreement - California, Page 1
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