• MC 1054 (6/07): Tsab Ntawv Qhia Txog Tus Muab Kev Pabcuam Medi-Cal uas Muaj Feem Sib Koom​​ 
• MC 1982 A (07/12) – SD/MC Quarterly Claim for Reimbursement – Treatment Cost​​ 
• MC 1982 B (07/12) – SD/MC Daim Ntawv Thov Nyiaj Rov Qab Txhua Peb Hlis – Tus Nqi Tswjfwm​​ 
  Lwm txoj: 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 Daim Ntawv Thov Nyiaj Rov Qab Txhua Peb Hlis – Medi-Cal Cov Haujlwm Tswjfwm (MAA)​​ 
  Alt: MC 1982 D – (Excel)​​