• MC 1054 (6/07)：成本分擔醫療服務提供者信​​ 
• MC 1982 A (07/12) – SD/MC Quarterly Claim for Reimbursement – Treatment Cost​​ 
• MC 1982 B (07/12) – SD/MC Quarterly Claim for Reimbursement – Administrative Cost​​ 
  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 Quarterly Claim for Reimbursement – Medi-Cal Administrative Activities (MAA)​​ 
  Alt: MC 1982 D – (Excel)​​