Follow the steps to successfully complete the Medi-Cal choice form online.

1. Click the ‘Get Form’ button to access the form in the online editing interface.
2. Begin by filling out section 1: Head of household name. Clearly print the first and last name of the head of household.
3. Next, provide the head of household's telephone number and home address, including house number, street, apartment number (if applicable), city, and zip code.
4. Move to section 2 to indicate your sex by marking the corresponding oval.
5. In section 3, input the applicant’s name, including first and last names, and repeat the sex indicator as in the previous section.
6. For pregnant applicants, provide the due date in section 6a and the Social Security number in section 6b.
7. Review the list of health plans provided and choose one for each member listed. Doctor/clinic codes can be found in the Health Plan Provider Directory.
8. If applicable, enter the plan change reason code from the provided options. This is essential for processing your form effectively.
9. Complete the choice statement, confirming that you understand the conditions of this agreement, and include signatures where required.
10. Finally, ensure that all sections are filled out clearly, save your changes, and prepare to download, print, or share the completed form.

Complete your Medi-Cal choice form online today to ensure your healthcare needs are met.