Form MC4035 Medi-Cal Consent Form - California (Tagalog)

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.

The document is provided in Tagalog. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the MC4035 Medi-Cal Consent Form?A: The MC4035 Medi-Cal Consent Form is a form used in California for individuals to provide consent for the disclosure of their protected health information in connection with their Medi-Cal benefits.

Q: What is Medi-Cal?A: Medi-Cal is California's Medicaid program, which provides free or low-cost health coverage to eligible low-income individuals and families.

Q: Who needs to complete the MC4035 Medi-Cal Consent Form?A: Anyone who receives Medi-Cal benefits in California and wishes to authorize the disclosure of their protected health information needs to complete the MC4035 Medi-Cal Consent Form.

Q: What information does the MC4035 Medi-Cal Consent Form authorize the disclosure of?A: The MC4035 form authorizes the disclosure of an individual's protected health information, including medical records, treatment history, and insurance information.

Q: Is the MC4035 Medi-Cal Consent Form available in languages other than English?A: Yes, the MC4035 Medi-Cal Consent Form is available in multiple languages, including Tagalog.

Q: What should I do with the completed MC4035 Medi-Cal Consent Form?A: Once completed, you should keep a copy of the form for your records and provide a copy to the entity or person you have authorized to disclose your protected health information.

Q: Is there a fee to complete the MC4035 Medi-Cal Consent Form?A: No, there is no fee to complete the MC4035 Medi-Cal Consent Form.

Q: Can I revoke my consent given on the MC4035 Medi-Cal Consent Form?A: Yes, you have the right to revoke your consent at any time by submitting a written revocation to the entity or person previously authorized to disclose your protected health information.

Q: Are there any exceptions to the confidentiality of the information disclosed on the MC4035 Medi-Cal Consent Form?A: Yes, there are certain exceptions, such as when the disclosure is required by law or necessary for emergency treatment.