Get Ca Mc 382 2018-2025

The CA MC 382 form is used to appoint an individual or organization as your authorized representative for Medi-Cal. This guide will provide clear, step-by-step instructions on how to complete the form online, ensuring that you can effectively communicate your preferences regarding your Medi-Cal representation.

Follow the steps to fill out the CA MC 382 form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part A, provide your details as the applicant or beneficiary. Fill in your name, phone number, mailing address, and optional case number.
3. In Part B, enter information about the authorized representative. Include their name, phone number, mailing address, and email address.
4. In Part C, specify the duties you want to assign to your authorized representative. You can choose to allow them to handle all listed responsibilities or limit their duties.
5. Indicate whether you want your authorized representative to receive copies of Medi-Cal notices and other mail by checking the appropriate box.
6. In Part D, review and sign the acknowledgment. Your signature and date are required to confirm your appointment of the authorized representative, as well as the optional signature of the representative themselves.
7. After completing the form, you can save your changes, download the document, print it, or share it as needed.

Start filling out the CA MC 382 form online today to ensure your Medi-Cal representation is appointed according to your wishes.