Fill and Sign California Legal Forms

This Form is used for applying for nonprofit recognition in California and receiving prompt payment benefits.

This type of document is used for submitting a new referral to the Genetic Handicap Program (GHPP) for individuals with genetic disabilities in California.

This Form is used for requesting the restriction of use and disclosure of protected health information at the Northern California Regional Office/San Francisco of the City and County of San Francisco, California.

This form is used for requesting to amend protected health information at the Southern California Regional Office in the City of Los Angeles, California.

This form is used for requesting an accounting of the disclosure of protected health information by a parent, guardian, or legal representative in the Genetically Handicapped Persons Program in California.

This Form is used for parents, guardians, or legal representatives in Sacramento, California to request the amendment of protected health information.

This document is a form used to request restrictions on the use and disclosure of protected health information in the Southern California Regional Office of the City of Los Angeles, California.

This form is used for requesting access to protected health information under the Genetically Handicapped Persons Program in California.

This form is used for requesting the suspension of Medi-Cal payment eligibility in California.

This Form is used for submitting drug Medi-Cal (Dmc) claims for Direct Contract Providers in California.

This document is used for submitting drug Medi-Cal (DMC) claims as a contracted provider in California. It provides instructions on how to complete the Form DHCS100186 for claiming reimbursement for DMC services.

This Form is used for submitting claims for Drug Medi-Cal services provided by County Operated Providers in California.

This Form is used for submitting drug Medi-Cal (Dmc) claims by County Operated Providers in California. The form serves as a certification for claim submission.

This Form is used for applying for Good Cause Certification in California. It is required for individuals who are seeking an exemption from certain Medi-Cal eligibility requirements.

This form is used for County/Direct Provider Approver Certification in the state of California. It is important for certifying individuals who approve certain services for county or direct providers.

This type of document is used for making a medical diagnosis report declaration in California.

This Form is used for healthcare providers and groups in California to affiliate or disaffiliate with the Medi-Cal program.

This form is used for county approvers and vendors to certify and appoint access to the California Outcomes Measurement System (Caloms Tx) in California.

This Form is used for providers to agree to the terms and conditions of the Medi-Cal program in California when applying for enrollment or continued enrollment.

This form is used for California physicians to apply for and agree to participate in the Medi-Cal program.

This form is used for applying for a Medi-Cal Clinical Medical Laboratory in California.

This form is used for applying to become a non-physician medical practitioner or licensed midwife under the Medi-Cal program in California.

This Form is used for disclosing information related to Medi-Cal benefits in the state of California.

This Form is used for institutional healthcare providers in California who wish to enter into a Medi-Cal provider agreement.

This form is used for individual physicians or dentists who are relocating their practices within the same county in California to make changes to their Medi-Cal location information.

This form is used to provide additional income and property information required for Medi-Cal in California.

This form is used for the monthly verification of trucking companies participating in the Disadvantaged Business Enterprise (DBE) and the Underutilized Disadvantaged Business Enterprise (UDBE) programs in California.

This form is used for recording contractor personnel training related to SWPPP/WPCP in California.

This document is a Construction Manual Proposed Change form (Form CEM-9001) used in California. It is used to propose changes in construction manuals.

This Form is used for the final acceptance checklist of Caltrans oversight projects in California.