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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYDEPARTMENT OF CHILD SUPPORT SERVICESMEDICAL INFORMATION VERIFICATION REPORT CSS 0020 (01/18/15)DATE:CASE NUMBER:INSTRUCTIONS: This form is designed
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How to fill out dcss-0020 medical information verification

01
To fill out the DCSS-0020 Medical Information Verification form, follow these steps:
02
Start by providing your case number, county of residence, and name.
03
Indicate your relationship to the child(ren) and provide their names and birth dates.
04
Fill in your contact information, including your address, phone number, and email.
05
Complete the section regarding the child(ren)'s medical insurance information, including policy number and coverage details.
06
Specify the child(ren)'s primary care physician and list any other medical specialists they see.
07
Provide information about the child(ren)'s medications, allergies, and any existing medical conditions.
08
Sign and date the form at the bottom.
09
Make a copy of the form for your records and submit the original to the appropriate entity.

Who needs dcss-0020 medical information verification?

01
The DCSS-0020 Medical Information Verification form is required for individuals involved in child support cases where medical support is involved.
02
This includes custodial parents, noncustodial parents, and any other parties responsible for providing medical support for the child(ren).
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DCSS-0020 medical information verification is a form used to confirm the accuracy and completeness of medical information provided by individuals or entities in relation to healthcare services.
Healthcare providers, insurance companies, and other entities that manage or provide medical information are typically required to file the DCSS-0020 medical information verification.
To fill out the DCSS-0020 form, provide all requested personal and medical information, ensure accuracy, sign the form where indicated, and submit it to the designated authority by the deadline.
The purpose of the DCSS-0020 medical information verification is to ensure that all medical information is accurate, legitimate, and in compliance with healthcare regulations.
Information that must be reported includes patient identification details, medical history, treatment information, and any relevant documentation supporting the medical claims.
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