Get Mc 330 Form

The Mc 330 Form, also known as the Newborn Referral Form, is essential for reporting the birth of a child to Medi-Cal. By accurately completing this form, users assist in confirming their newborn's eligibility for Medi-Cal services. This guide provides a clear, step-by-step approach to filling out the form online.

Follow the steps to complete the Mc 330 Form online effectively.

1. Click ‘Get Form’ button to access the form and open it in your preferred online document editor.
2. In Section A, provide the mother’s details. Enter their full name (first, middle initial, last), date of birth, and either the Benefits Identification Card (BIC) number or Social Security Number (SSN). Include their complete mailing address, city, county, state, ZIP code, and telephone number.
3. Move to Section B to fill out the newborn's information. For each child, enter their full name, date of birth, and gender. If available, include their optional BIC number. Provide details for each newborn listed, up to five children.
4. Indicate the place of birth, including the hospital or clinic name and the address if known. This information is crucial for verification purposes.
5. In Section C, if the form is completed by someone other than a parent, relative, or guardian, input the name, title, and National Provider Identifier (NPI) number if applicable. Also, provide the telephone number and sign to certify the accuracy of the information.
6. Once all required fields are completed, review the form for accuracy to ensure all details are correct.
7. Finally, save your changes, download the completed form, and prepare to print or share it. Ensure it is submitted to the appropriate county office either by mailing or faxing.

Complete your Mc 330 Form online today to ensure your newborn receives the necessary Medi-Cal services.