Get the free Medi-Cal Choice Form - Family Health Centers of San Diego
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Mail form back to: California Department of Health Care Services P.O. Box 989009 W. Sacramento, CA 957989850 Use this form to join or change plans. For help, call 18004304263. Please print. Fill in
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How to fill out medi-cal choice form
How to fill out medi-cal choice form
01
Obtain a copy of the Medi-Cal Choice form from the Medi-Cal office or website.
02
Fill out your personal information, including name, address, date of birth, and Social Security number.
03
Indicate your choice of health plan by selecting the corresponding box or writing in the plan name.
04
Provide any additional information or documentation required by the form.
05
Review the completed form for accuracy and sign and date it before submitting.
Who needs medi-cal choice form?
01
Individuals who are eligible for Medi-Cal benefits and wish to choose a specific health plan need to fill out the Medi-Cal Choice form.
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What is medi-cal choice form?
The medi-cal choice form is a document used to select the type of Medi-Cal plan an individual wishes to enroll in.
Who is required to file medi-cal choice form?
Individuals who are eligible for Medi-Cal and wish to enroll in a specific plan are required to file the medi-cal choice form.
How to fill out medi-cal choice form?
The medi-cal choice form can be filled out by providing personal information, selecting a Medi-Cal plan, and signing the document.
What is the purpose of medi-cal choice form?
The purpose of the medi-cal choice form is to allow individuals to choose the Medi-Cal plan that best suits their needs.
What information must be reported on medi-cal choice form?
The medi-cal choice form requires information such as personal details, preferred Medi-Cal plan, and signature.
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