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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHCS9113
for the current year.
Form DHCS9113 Appointment of Representative (Or Additional Contact) - (Optional) - California
What Is Form DHCS9113?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DHCS9113?
A: Form DHCS9113 is the Appointment of Representative (Or Additional Contact) form.
Q: When should I use Form DHCS9113?
A: You should use Form DHCS9113 if you want to appoint a representative or provide an additional contact for your California healthcare services.
Q: Is filling out Form DHCS9113 mandatory?
A: No, filling out Form DHCS9113 is optional.
Q: What is the purpose of appointing a representative?
A: Appointing a representative allows someone else to assist you with your healthcare services and communicate with the California Department of Health Care Services on your behalf.
Q: Can I add an additional contact on Form DHCS9113?
A: Yes, you can also provide an additional contact on Form DHCS9113 if you wish to have someone else receive information about your healthcare services.
Form Details:
- Released on March 1, 2021;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DHCS9113 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
