Representatives Forms for Orange
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FAQ
Someone who you choose to act on your behalf with the Marketplace, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf.
MC 382 (6/18) Use this form to appoint an individual or organization as your Medi-Cal authorized representative. Your authorized representative may act for you on all duties related to your Medi-Cal eligibility and enrollment. Or, you may also limit duties. You may cancel or change this appointment at any time.
An Authorized Representative is someone you can name and give access to your Protected Health Information (PHI). An Authorized Representative can be family members, friends, or any other individual you choose.
MC-306 (DOT-406)Non (low) pressure bulk liquid cargo tank. 2022 MC 306--Maximum operating pressure of up to 3 psi. 2022 DOT 406--Maximum operating pressure of up to 4 psi. 2022 Oval or egg shaped cross section. 2022 Flat or nearly flat ends.
You may give this form to your local county office in person or by mail, phone or electronically. Use this form to appoint an individual or organization as your Medi-Cal authorized representative. any time. You may give this form to your local county office in person or by mail, phone or electronically.