• MC 1054 (6/07): اشتراک هزینه نامه ارائه دهنده Medi-Cal
• MC 1982 A (07/12) – SD/MC Quarterly Claim for Reimbursement – Treatment Cost
• MC 1982 B (07/12) – SD/MC Quarterly Claim for Reimbursement – Administrative Cost
  Alt: MC 1982 B (Excel)
• MC 1982 C (07/12) – SD/MC Monthly Claim for Reimbursement – Quality Assurance/Utilization Review (QA/UR) Cost
• MC 1982 D (07/12) – SD/MC Quarterly Claim for Reimbursement – Medi-Cal Administrative Activities (MAA)
  Alt: MC 1982 D – (Excel)