收款人数据记录 (STD 204)
第三方责任和追偿部门 (TPLRD) 可能会处理付款请求，以偿还健康保险公司、提供商、Medi-Cal 成员和律师的多付款、误付款和重复付款。其他付款包括乳腺癌和宫颈癌治疗计划（BCCTP）和健康保险费支付（HIPP）计划。
TPLRD’s payment process has changed. Both state and federal laws require that all reportable payments be identified and reported in the Payee Data Record (STD 204) form. This includes any state department that participates in a transaction resulting in a payment to any individual or entity that is not a governmental entity.
法定权力：
自1 、 2012 1 月 20 日起，TPLRD 将要求所有支付给个人或非政府实体的款项均须填写 STD 204 表格。此表格必须由收款人填写，并在申请退款或付款之前由卫生保健服务部 (DHCS) 保留在机密文件中。
The form is available for download using this link: STD 204. Please carefully read the instructions provided on the second page of the STD 204 before completing the form. If an STD 204 is not properly completed as indicated in the instructions and filed with DHCS, your refund or payment request is subject to rejection. If the payee’s name and/or address changes, the payee must submit a new STD 204 with their current information.
The payee seeking payment could contact their TPLRD program representative for instructions on electronically sending a copy of the completed STD 204. The original signed copy of the completed STD 204 must be mailed to one of the following addresses below, or as instructed by your program representative.
TPLRD 邮寄地址：
卫生保健服务部
第三方责任和恢复部门，MS 4720
PO邮政信箱 997425
萨克拉门托，CA 95899-7425