Medi-Cal forms & documents 2026

1. Click ‘Get Form’ to open the Authorized Representative Form in the editor.
2. In Section 1, fill in your personal details as the Member or Minor’s parent/guardian. Include your Name, Member ID, Date of Birth, Telephone Number, and Address. Ensure you sign and date the form.
3. Proceed to Section 2. Here, check each box to acknowledge that you have read the conditions regarding the authorization of your representative. Specify an expiration date for this appointment if desired.
4. In Section 3, your appointed representative(s) must complete their information. They should provide their Name, Organization (if applicable), Relationship/Professional Status, Telephone Number, Address, and Signature along with the date.

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