This form is used to inform the plaintiff's medical provider that an attorney has been retained by plaintiff and that plaintiff authorizes the release to attorney of all of his or her medical records.
Contra Costa California Authorization for Medical Information
State:
Multi-State
County:
Contra Costa
Control #:
US-PI-0244
Format:
Word;
Rich Text
Instant download
Description
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
The Contra Costa Health Plan includes Medi-Cal, which provides low-income residents with access to essential health services. It ensures that vulnerable populations receive the care they need without financial strain. If you need assistance with the Contra Costa California Authorization for Medical Information, understanding Medi-Cal's benefits can be very helpful.
You may call us at 925-655-2710 or toll free at 877-646-8314. You can also submit a Code Enforcement complaint online.
This guidebook explains the two kinds of Medi-Cal: Regular Medi-Cal and Medi-Cal Health Plans.
How Do I Apply? Call toll-free 1-800-709-8348 in Contra Costa County or visit the Contra Costa Employment and Human Services Department Medi-Cal website.
Contra Costa County residents can apply by: Online at MyBenefits CalWIN or Covered California. Call 1-877-505-4630 to begin the process over the phone or request an application be mailed to you.
Contra Costa Health Plan (CCHP) has a Medi/Cal contract with the California Department of Health Care Services (DHSC).
Contra Costa Health Plan (CCHP) was the first federally qualified, state licensed, county sponsored HMO in the United States. CCHP has been serving the health needs of people in Contra Costa County for over 45 years, and now serves over 227,000 people.
Medi-Cal offers low-cost or free health coverage to eligible Californian residents with limited income. Covered California is the state's health insurance marketplace where Californians can shop for health plans and access financial assistance if they qualify for it.
Call us at 1-877-661-6230 Available 24 hours a day, 7 days a week, 365 days a year. (For medical emergencies, please call 911.)
Contact Us 925-957-2200. 925-646-2566 (Fax) To send the DA's Office an email, please email DAOffice@contracostada.org. Office locations and maps click here.