收款人資料記錄 (STD 204)
第三方責任及追討部 (TPLRD) 可能會處理由健康保險運營商、提供商、Medi-Cal 成員和律師所提供的超額付款、錯誤導向付款和重複付款的付款要求。其他支付包括乳房和子宮頸癌治療計劃（BCCTP）和健康保險費用支付（HIPP）計劃。
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.
法定權力：
從 1 月 2012 日起，TPLRD 將要求所有付款給非政府實體的個人或實體，必須填寫 STD 204 表格。此表格必須由收款人填寫，並將在要求退款或付款前由衞生護理服務部（DHCS）保存在機密文件中。
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.
台灣地區郵寄地址：
衞生護理署第
三者責任及復原科，MS 4720 郵政
局箱子 997425 薩克拉門
托，加利福尼亞州 95899-7425