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Appointment of Authorized Representative Part A: Tell us …
https://www.dhcs.ca.gov/formsandpubs/forms/Forms/MCED/MC_Forms/MC382_0618.pdf
WEB• The only persons who may perform duties authorized on this form are those who represent the organization and have a signed Authorized Representative Standard Agreement (MC 383) on file with the county that handles the applicant or beneficiary’s Medi-Cal case. • The organization must fully disclose in writing to the applicant or beneficiary
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Medi-Cal Forms - DHCS
https://www.dhcs.ca.gov/formsandpubs/forms/Pages/Medi-CalForms.aspx
WEBSep 18, 2023 · Estate Recovery Forms. Health Insurance Premium Program (HIPP) Application. Health Insurance Premium Payment Program. Medi-Cal Personal Injury Program. Quality Assurance Fee Program. Third Party Liability Notification. Dental, Request for Access to Protected Health Information. Notice to Terminating Employees.
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Authorized Representative Standard Agreement for …
https://www.dhcs.ca.gov/formsandpubs/forms/Forms/MCED/MC_Forms/MC383_0618.pdf
WEBorganization that the Medi-Cal applicant or beneficiary has appointed as an authorized representative. The organization must give this signed and completed form to the county that handles the Medi-Cal case of the applicant or beneficiary. It can be given by mail, phone, electronically or in person.
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Form MC382 - Fill Out, Sign Online and Download Fillable PDF, California
https://www.templateroller.com/template/2017213/form-mc382-appointment-of-authorized-representative-california.html
WEBDownload Fillable Form Mc382 In Pdf - The Latest Version Applicable For 2024. Fill Out The Appointment Of Authorized Representative - California Online And Print It Out For Free. Form Mc382 Is Often Used In California Department Of Health Care Services, California Legal Forms And United States Legal Forms. Reviews: 22
Reviews: 22
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Authorized Representative Forms and Updated Procedures …
http://www.calsaws.org/wp-content/uploads/2020/05/DRAFT-CA-206898-Authorized-Representative-Forms-and-Updated-Procedures-for-Medi-Cal.pdf
WEBRequest: Per ACWDL 18-26- Provide counties with the new forms, notices and policies for the designation of a Medi-Cal authorized representative (AR). Recommendation: Add the following Forms to the LRS/CalACES system: 1. MC 382- Appointment of Authorized Representative also known as "Appointment Form MC 382" 2.
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Authorized Representative Forms and Updated Procedures …
http://www.calsaws.org/wp-content/uploads/2020/05/DRAFT-CIV-102914-Authorized-Representative-Forms-and-Updated-Procedures-for-Medi-Cal.pdf
WEBnew forms, notices and policies for the designation of a Medi-Cal authorized representative (AR) and. to provide instruction regarding these forms: 1. “Appointment of Authorized Representative” form (MC 382). Otherwise referred to as “Appointment. Form MC 382” or “MC 382” in this ACWDL;
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Form MC382 - Fill Out, Sign Online and Download Fillable PDF, California
https://www.templateroller.com/template/2260954/form-mc382-appointment-of-authorized-representative-california-mien.html
WEBFill and download the Form MC382 Appointment of Authorized Representative - California (Mien) online. Generate a printable PDF version or download a blank form in PDF and Word formats. Reviews: 5
Reviews: 5
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MC382: Appointment of Authorized Representative
https://assets.ctfassets.net/4wgj8epkji5y/3JfSmox54ZdA2YGfOJkCiD/4c6a8579e16decfbcf6b677b257698c5/MC382_0618__20201124.pdf
WEBNov 24, 2020 · Use this form to appoint an individual or organization as your Medi-Cal authorized representative. Your authorized representative may act for you on all duties related to your Medi-Cal eligibility and enrollment. Or, you may also limit duties. You may cancel or change this appointment at any time.
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Get Medi-Cal or Keep Medi-Cal
http://medi-cal.dhcs.ca.gov/
WEBDec 14, 2023 · Get Medi-Cal. Even if you’ve been denied recently, you may be eligible now.
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Medi-Cal Eligibility Division MC 300 Forms - DHCS
https://www.dhcs.ca.gov/formsandpubs/forms/Pages/MCEDFormsMC300.aspx
WEBSep 19, 2023 · MC 300 Forms: MC 306 (11/15) - Appointment of Representative; Alt: Spanish (01/08) MC 322 (05/07) - Real and Personal Property - Supplement to Medi-Cal Mail-in Application; Alt: Spanish (09/07) MC 324 (05/07) - Sneede v. Kizer Section 1931(b) Property Work Sheet MC 325 (05/07) - Request for Transitional Medi-Cal (TMC) or Four Month Continuing ...
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