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Medi-Cal Members:
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your county office
to update your information.
Important
Are you enrolled in Medi-Cal? Has your contact information changed in the past two years? Give your local county office your updated contact information so you can stay enrolled.
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Forms
Authorization Requests
CCS/GHPP Discharge Planning Service Authorization Request (SAR)
(DHCS 4489)
Established CCS/GHPP Client Service Authorization Request (SAR)
(DHCS 4509)
New Referral CCS/GHPP Client Service Authorization Request (SAR)
(DHCS 4488)
GHPP Dental Client Service Authorization Request (SAR)
(MC 2361)
Referrals and Evaluations
GHPP/CCS Annual Hemophilia Comprehensive Center Evaluation
(DHCS 9054)
GHPP New Referral Form
(
DHCS 9052)
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Last modified date: 2/3/2025 1:10 PM
