PDF
Word
Form DMHC20-174 Legal Representative for Deceased Patient Form - California
What Is Form DMHC20-174?
This is a legal form that was released by the California Department of Managed Health Care - 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 the DMHC20-174 form?
A: The DMHC20-174 form is the Legal Representative for Deceased Patient Form in California.
Q: What is the purpose of the DMHC20-174 form?
A: The purpose of the DMHC20-174 form is to designate a legal representative for a deceased patient in California.
Q: Who needs to fill out the DMHC20-174 form?
A: The DMHC20-174 form should be filled out by the legal representative of a deceased patient in California.
Q: What information is required on the DMHC20-174 form?
A: The DMHC20-174 form requires information such as the legal representative's contact details, relationship to the deceased patient, and authorization to act on behalf of the deceased patient.
Q: Are there any fees associated with the DMHC20-174 form?
A: No, there are no fees associated with the DMHC20-174 form.
Q: What happens after submitting the DMHC20-174 form?
A: After submitting the DMHC20-174 form, the legal representative will be recognized as the authorized representative for the deceased patient's healthcare matters in California.
Q: Can the DMHC20-174 form be revoked or updated?
A: Yes, the DMHC20-174 form can be revoked or updated by submitting a new form with the updated information or a revocation request.
Q: Is the DMHC20-174 form only applicable in California?
A: Yes, the DMHC20-174 form is specific to California and may not be valid in other states.
Form Details:
- Released on April 1, 2020;
- The latest edition provided by the California Department of Managed Health Care;
- 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 printable version of Form DMHC20-174 by clicking the link below or browse more documents and templates provided by the California Department of Managed Health Care.
