Get Ca Mc 61 2020-2025

Filling out the CA MC 61 form online is essential for those who need to apply for Medi-Cal or MCAP postpartum care extensions. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the CA MC 61 online.

1. Click ‘Get Form’ button to obtain the CA MC 61 form and access it in the online editor.
2. In Section I, enter the patient/client's information accurately. This includes their full name (last, first, middle), birth date, and either their Social Security number, Medi-Cal number, or MCAP number.
3. In the medical release section, indicate the name of the licensed physician or certified psychologist and the name of the clinic or medical group authorized to release medical information.
4. Ensure you sign and date the authorization, affirming that the medical information can be released to the county Medi-Cal department or MCAP program as required.
5. Proceed to Section II to answer whether the patient has been diagnosed with a maternal mental health condition. Specify the onset date if applicable.
6. The treating health care provider must sign the form, including their printed name, title, phone number, and mailing address.
7. After completing all sections, review the information for accuracy. You can then save changes, download, print, or share the final form as needed.

Get started now and fill out your CA MC 61 online for a seamless application process.