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​​​​​​Medical Exemption Request Documentation

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 links below to download the request form.

Click on the appropriate link below to download the fillable request form.  After completion of the form, you can email the form to the Managed Care Quality & Monitoring Division, State Hearing Unit, or you can mail to the address listed on the form.

Individuals

Visit the Medical Exemption Request Documentation​ page​​ if you are requesting the information for yourself.

Parent, Guardian, or Personal Representative

If you are the parent, guardian, or personal representative, see DHCS Form 6236 Request for Authorization for Release of Protected Health Information​.​
Last modified date: 9/5/2025 12:43 PM