Fill and Sign United States Legal Forms

This Form is used for certifying a valid reason for not meeting certain requirements in California.

This form is used for individuals in California to provide a good cause certification for certain health care eligibility requirements.

This form is used for requesting a good cause certification in California, which allows individuals to qualify for certain healthcare programs or exemptions.

This Form is used for providers in California who have a direct contract with Drug Medi-Cal (DMC) to submit their claims and certify their submission. It provides step-by-step instructions for completing the form and ensuring proper claim submission and certification.

This Form is used for submitting a Multiple Billing Override Certification in the state of California. It provides instructions on how to correctly complete the form and ensure compliance with applicable regulations.

This form is used for California county contracted providers to certify their submission of Drug Medi-Cal (DMC) claims.

This Form is used for County Certification of Compliance with Drug Medi-Cal Post Service Post Payment Corrective Action Plan in California. It provides instructions on how to certify compliance with the corrective action plan.

This form is used for obtaining employee approver certification in California under DHCS (Department of Health Care Services).

This Form is used for canceling the county/direct provider user registration in California.

This form is used for Drug Medi-Cal certification in California to seek federal reimbursement for drug treatment services.

This form is used for reporting infant-related information in Region C of California.

This form is used for reporting information about infants in Region a/B of California.

This form is used for reporting information related to infants in Region D, California.

This Form is used for healthcare providers in California to participate in the Medi-Cal Ground Emergency Medical Transportation Services (GEMT) Supplemental Reimbursement Program.

This form is used for requesting a waiver for hearing screening in California.

This document provides the point of contact information for ground emergency medical transportation in California.

This form is used for reporting the quarterly progress of the American Indian Infant Health Initiative (AIIHI) in California.

This form is used for the American Indian Infant Health Initiative (Aiihi) Database in California.

This form is used for reporting the enrollment and licensing information of participants in a 6-month DUI program in California on a quarterly basis.