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Get Ca Medi-cal Choice Form
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How to fill out the CA Medi-Cal Choice Form online
Completing the CA Medi-Cal Choice Form is an essential step in selecting your health care options under the Medi-Cal program. This guide provides clear, user-friendly instructions to help you fill out the form accurately and efficiently.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to obtain the CA Medi-Cal Choice Form and open it in the document editor.
- Begin by filling in the head of household section. Enter the first and last names of the head of household, their phone number, and home address. Make sure to indicate their sex using the provided options.
- For each person in your household who is receiving Medi-Cal, fill out the corresponding sections. Provide their first and last names, social security numbers, and select their desired health plan from the options.
- If you have more than three family members applying, you need to contact the provided number to request an additional form.
- In the section regarding changing health plans, indicate any reasons for the change by checking the appropriate boxes or writing in your reasons.
- Read and understand the statement of understanding regarding the use of your information by the Department of Health Care Services.
- Sign the form where indicated. If the applicant is under 18 years old, a parent or guardian should sign on their behalf.
- Finally, save your changes, then download, print, or share the completed form as needed.
Complete your CA Medi-Cal Choice Form online today to ensure your health care needs are met.
If you need assistance with filling out your Medi-Cal form, consider reaching out to local community organizations or the Medi-Cal helpline. These resources can provide personalized guidance. Additionally, our US Legal Forms platform offers user-friendly templates and instructions that simplify form completion.
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