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STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF HEALTH CARE SERVICES PRIVACY OFFICE AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION I, , hereby authorize (Name of patient).

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DHCS 6247 (11/07) - Authorization for Release of...
By completing this form you are authorizing the California Department of Health. Care...
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Other Health Coverage Forms To request changes to a beneficiary​'s OHC, please use the forms below or call 1-800-541-5555. If you're located outside of California, please dial 1-916-636-1980. Please allow up to 72 business hours for your request to be processed.

​Steps to Medi-Cal​ Medi-Cal is California's Medicaid program. This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources.

If you are a provider type not yet eligible to submit an application via PAVE, you can request that a Medi-Cal enrollment application be mailed to you by calling the Medi-Cal Provider Service Center at (800) 541-5555(outside of California, please call (916) 636-1980).

​ Helpful Hints & Resources Lost or stolen Medi-Cal Beneficiary Identification Cards (BIC): If you have just lost your BIC card, contact your local county worker for a replacement. ... The California Medical Board: (800) 430-4263. Medi-Cal Managed Care Ombudsman: (888) 452-8609. Medi-Cal Billing: (800) 541-5555.

Haven't received your member medical ID card yet? Or do you need to go to a doctor's appointment before you get it? There's no need to worry – you can always print a temporary ID card. It'll work just as well as the real thing.

Online: Apply online at .CoveredCA.com . Applications are securely transferred directly to your local county social services office, since Medi-Cal is provided at the county level.

Call Health Care Options (HCO) Medi-Cal Managed Care at 1-800-430-4263 (TTY 1-800-430-7077). The call is free.

This California HIPAA release form enables patients to permit any person or 3rd party organization to have access to their personal health records. The HIPAA release form also optionally allows healthcare providers to share health information with each other.

Telephone Service Center: (800) 541-5555....Beneficiary questions on: Medi-Cal Eligibility. Benefits. Benefits Identification Card.

If You Do Not Receive Your ID Card or You Lost It Call 1-888-839-9909 (TTY: 711).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232