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Click ‘Get Form’ to open the mc 382 in the editor.
Begin with Part I—Personal Information. Fill in your name, Social Security number, date of birth, and other personal details as required.
In Part II—Medical Information, indicate if you have applied for Social Security Disability benefits and provide details about your medical history.
Proceed to Part III—Social and Educational Information. Describe your daily activities and educational background accurately.
Complete Part IV—Work History by detailing your job experiences over the last 15 years, including job titles, responsibilities, and any medical issues related to your work.
Finally, sign and date the form in Part V—Signature and Certification to confirm that all information is true.
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Designation Notice, form WH-382 informs the employee whether the FMLA leave request is approved; also informs the employee of the amount of leave that is designated and counted against the employees FMLA entitlement. FMLA: Forms | U.S. Department of Labor U.S. Department of Labor agencies whd fmla forms U.S. Department of Labor agencies whd fmla forms
What is the new law for Medi-Cal in California?
Starting July 1, 2027, certain adult Medi-Cal members who do not have a satisfactory immigration status must pay $30 per month to keep full scope Medi-Cal.
What is form mc 382?
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.
What is a Medi-Cal authorized representative?
Medi-Cal applicants and participants can designate individuals, such as their family members or friends, or organizations as an authorized representative (AR) for help communicating with Medi-Cal about enrollment and eligibility.
What is the MC 382 form?
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. MC 382 (6/18) - DHCS DHCS (.gov) MCED MCForms DHCS (.gov) MCED MCForms PDF
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mc 382
Information for All Providers - Third Party
Mar 15, 2008 For Medicaid Prepaid Capitation Plans only, the two-digit plan code and up to. 20 alphabetic coverage codes, or the word ALL indicating
Use this form to appoint an individual or organization as your Medi-Cal authorized representative. Your authorized representative may act for you on all
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