You have the right to inspect, review, and receive a copy of your Medical Exemption Request (MER) documentation.  You must be the individual, or the parent, guardian, or personal representative of the individual for whom you seek documentation. To request documentation of your Medical Exemption Request documents, please use the link below to download the request form.​​ 

Click on the link below to download the fillable request form.  After completion of the form please mail the form to:​​ 

Department of Health Care Services
DHCS/MEDI-CAL FI
P.O. Box 526018
Sacramento, CA 95852-6018
(916) 636-1980​​ 

Individual, Parent, Guardian, or Personal Representative​​ 

If you are the individual, parent, guardian, or personal representative, see DHCS Form 6236 Request for Authorization for Release of Protected Health Information.
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