Contra Costa California Personal Representative Request Form
Description
How to fill out Personal Representative Request Form?
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FAQ
To check if you have a court date or a warrant in Contra Costa County, you can visit the county court's official website. They provide an online portal where you can search for your case information using your name or case number. Additionally, you can contact the court clerk’s office directly for assistance. Utilizing resources from US Legal can also help you find necessary forms and guidance, such as the Contra Costa California Personal Representative Request Form.
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.
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.
You may apply for Medicaid in the state you move to. If you are moving to a new county in California, you also need to tell the county you live in or the county you are moving to. This is to make sure you keep getting Medi-Cal benefits. You should tell your local county office within 10 days of moving to a new county.
?(800) 541-5555 Medi-Cal Members and Providers: If you have a question, need help, or need to report a problem, please call (800) 541-5555 (outside of California, please call (916) ?636-1980) for our Telephone Service Center.
To change or remove your authorized representative, or for more information, contact the Marketplace Appeals Center at 1-855-231-1751. TTY users can call 1-855-739-2231.
?Yes, you may be reimbursed for Retro Active Medi-Cal expenses up to three months from the date you applied for Medi-Cal. For further information, please contact your local County office.
You may give this form to your local county office in person or by mail, phone or electronically.
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.