• MC 1054 (6/07)： Medi-Cal费用分摊提供者函​​ ​
• MC 1982 A (07/12) – SD/MC Quarterly Claim for Reimbursement – Treatment Cost​​ ​
• MC 1982 B (07/12) – SD/MC 季度报销申请 – 管理费用​​ ​
  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 季度报销申请 – Medi-Cal 行政活动 (MAA)​​ ​
  Alt: MC 1982 D – (Excel)​​ ​