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Get Dhcs 7107

Submitted by Medi-Cal Managed Care Plan Provider 16. Phone including ext. Email 17. Signature of person completing form Please note When applicable both Medi-Cal Managed Care Plans MCP and Medicare-Medicaid Plans MMP are required to report PPCs using this form. DHCS 7107 rev. 2/15 www. State of California Health and Human Services Agency Department of Health Care Services Medi-Cal Provider-Preventable Conditions PPC Reporting Form By law provid.

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