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Get CA DHCS 6207 2011

result in a denial of enrollment and imposition of a three-year reapplication bar. ï‚· FOR CURRENTLY ENROLLED APPLICANTS: Failure to disclose complete and accurate information may result ï‚· ï‚· ï‚· ï‚· ï‚· in denial, deactivation of all business addresses and the imposition of a three-year reapplication bar. Submitting a complete and accurate Medi-Cal Disclosure Statement is required. Read all instructions when completing the Medi-Cal Disclosure Statement. Type or print clearly in ink. DO .

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