This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHCS8049
for the current year.
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. Check the official instructions before completing and submitting the form.
Form Details:
Download a fillable version of Form DHCS8049 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.