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Home | Members | Medi-Cal | Important Documents

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Important Documents

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Primary Care Provider (PCP) Selection Form
California Advance Health Care Directive
Assignment of Authorized Representative
Authorization to Release Medical Information
Designated Personal Representative Form
Claim Request Form
Request for Reimbursement
Health Information Form
Health Risk Assessment Form
Pediatric Health Risk Assessment Form
Health Information Exchange Form

Who we are

Partnership HealthPlan of California is a non-profit community based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

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