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This form is used by counties in California to report on revenue and expenditure details related to the Mental Health Services Act for the fiscal year 2022-23. It includes sections for various mental
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01
Obtain the DHCS 1822 A 0219 form from the official website or your local DHCS office.
02
Read the instructions carefully to understand the purpose of the form.
03
Fill in the provider information in the designated sections, ensuring accuracy.
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Complete the patient information fields, providing all necessary details such as name, date of birth, and Medi-Cal number.
05
Indicate the type of service or equipment being requested.
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Attach any additional documentation required to support the request.
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Review the completed form for any errors or missing information.
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Sign and date the form where required.
09
Submit the form to the appropriate DHCS office, either by mail or electronically, as specified.

Who needs dhcs 1822 a 0219?

01
Healthcare providers who are seeking authorization for services or equipment for Medi-Cal beneficiaries.
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Patients who are enrolled in Medi-Cal and require specific services or equipment that must be pre-approved.
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