- Legal
- United States Legal Forms
- California Legal Forms
- California Department of Managed Health Care
Documents
32
![Formulario DMHC62-226 "Formulario De Queja Acceso Idioma" - California (Spanish)](https://data.templateroller.com/pdf_docs_html/2100/21005/2100553/formulario-dmhc62-226-formulario-de-queja-acceso-idioma-california-spanish.png "Formulario DMHC62-226 "Formulario De Queja Acceso Idioma" - California (Spanish)")
Formulario DMHC62-226 "Formulario De Queja Acceso Idioma" - California (Spanish)
Size: 71 KB
3 pages
![Form DMHC62-226 "Language Access Complaint Form" - California](https://data.templateroller.com/pdf_docs_html/2100/21005/2100552/form-dmhc62-226-language-access-complaint-form-california.png "Form DMHC62-226 "Language Access Complaint Form" - California")
![Form DMHC20-174 "Legal Representative for Deceased Patient Form" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225147/form-dmhc20-174-legal-representative-for-deceased-patient-form-california.png "Form DMHC20-174 "Legal Representative for Deceased Patient Form" - California")
![Form DMHC20-160 "Authorized Assistant Form" - California](https://data.templateroller.com/pdf_docs_html/2063/20630/2063000/form-dmhc20-160-authorized-assistant-form-california.png "Form DMHC20-160 "Authorized Assistant Form" - California")
![Formulario DMHC20-160 "Formulario De Asistente Autorizado" - California (Spanish)](https://data.templateroller.com/pdf_docs_html/2063/20630/2063001/formulario-dmhc20-160-formulario-de-asistente-autorizado-california-spanish.png "Formulario DMHC20-160 "Formulario De Asistente Autorizado" - California (Spanish)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California](https://data.templateroller.com/pdf_docs_html/2063/20630/2063002/form-dmhc20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California")
![Form DMHC10-195 "Pre-filing Request Form" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225157/form-dmhc10-195-pre-filing-request-form-california.png "Form DMHC10-195 "Pre-filing Request Form" - California")
![Form DMHC10-242 "Application Form for Pharmacy Benefit Manager Registration" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225159/form-dmhc10-242-application-form-for-pharmacy-benefit-manager-registration-california.png "Form DMHC10-242 "Application Form for Pharmacy Benefit Manager Registration" - California")
![Form DMHC10-112 "Notice of Eap Exemption Form" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225161/form-dmhc10-112-notice-of-eap-exemption-form-california.png "Form DMHC10-112 "Notice of Eap Exemption Form" - California")
![Formulario DMHC20-224 "Formulario De Queja/Solicitud De Revision Medica Independiente (Imr)" - California (Spanish)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787904/form-dmhc-20-224-formulario-de-queja-solicitud-de-revision-medica-independiente-imr-california.png "Formulario DMHC20-224 "Formulario De Queja/Solicitud De Revision Medica Independiente (Imr)" - California (Spanish)")
![Form DMHC20-224 "Independent Medical Review Application (Imr)/Complaint Form" - California (Hmong)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787907/form-dmhc-20-224-independent-medical-review-application-imr-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review Application (Imr)/Complaint Form" - California (Hmong)")
![Form DMHC20-224 "Independent Medical Review Application (Imr)/Complaint Form" - California (Arabic)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787908/form-dmhc-20-224-independent-medical-review-application-imr-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review Application (Imr)/Complaint Form" - California (Arabic)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Hindi)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787909/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Hindi)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Armenian)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787910/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Armenian)")
![Form DMHC20-224 "Imr Application/Complaint Form" - California (Chinese)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787911/form-dmhc-20-224-imr-application-complaint-form-california.png "Form DMHC20-224 "Imr Application/Complaint Form" - California (Chinese)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Farsi)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787913/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Farsi)")
![Form DMHC20-224 "Independent Medical Review Application (Imr)/Complaint Form" - California (Tagalog)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787914/form-dmhc-20-224-independent-medical-review-application-imr-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review Application (Imr)/Complaint Form" - California (Tagalog)")
![Form DMHC20-224 "Imr Application/Complaint Form" - California (Korean)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787929/form-dmhc-20-224-imr-application-complaint-form-california.png "Form DMHC20-224 "Imr Application/Complaint Form" - California (Korean)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Japanese)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787930/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Japanese)")
![Form DMHC20-224 "Imr Application/Complaint Form" - California (Vietnamese)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787938/form-dmhc-20-224-imr-application-complaint-form-california.png "Form DMHC20-224 "Imr Application/Complaint Form" - California (Vietnamese)")
![Form DMHC20-224 "Imr Application/Complaint Form" - California (Khmer)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787912/form-dmhc-20-224-imr-application-complaint-form-california.png "Form DMHC20-224 "Imr Application/Complaint Form" - California (Khmer)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Thai)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787919/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Thai)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Punjabi)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787920/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Punjabi)")
![Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Lao)](https://data.templateroller.com/pdf_docs_html/1787/17879/1787922/form-dmhc-20-224-independent-medical-review-imr-application-complaint-form-california.png "Form DMHC20-224 "Independent Medical Review (Imr) Application/Complaint Form" - California (Lao)")
![Form DMHC10-0066 "Electronic Filing Signature Verification" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225152/form-dmhc10-0066-electronic-filing-signature-verification-california.png "Form DMHC10-0066 "Electronic Filing Signature Verification" - California")
!["Cobra Continuation Services - Benefit Termination Form" - California](https://data.templateroller.com/pdf_docs_html/8/84/8466/cobra-continuation-services-benefit-termination-form-california.png ""Cobra Continuation Services - Benefit Termination Form" - California")
!["California Managed Care Members Grievance Form" - California](https://data.templateroller.com/pdf_docs_html/7/73/7302/california-managed-care-members-grievance-form-california.png ""California Managed Care Members Grievance Form" - California")
!["Qualified Dental and Health Plans Filing Worksheet" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225166/qualified-dental-and-health-plans-filing-worksheet-california.png ""Qualified Dental and Health Plans Filing Worksheet" - California")
!["Subcontractor Worksheet" - California](https://data.templateroller.com/pdf_docs_html/2225/22251/2225158/subcontractor-worksheet-california.png ""Subcontractor Worksheet" - California")
