Get the free Every applicant or provider must complete and submit a current Medi-Cal Disclosure S...
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If yes provide the following information regarding Lessor a. Lessor name b. Lessor address number street c. Lessor telephone number d. For example Physicians Pharmacy providers Chiropractors Osteopaths Certified Nurse Midwives and Nurse Practitioners do not need to notarize this form. Durable Medical Equipment DME providers Prosthetists Orthotists Medical Transportation providers etc. must notarize this FOR MORE INFORMATION PLEASE VISIT THE MEDI-CAL WEBSITE WWW.MEDI-CAL.CA. 75 DHCS 6207 Rev....
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