Mc 306 sp form 2026

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The document is a form from the California Department of Health Care Services that allows a Medi-Cal applicant or beneficiary to appoint an authorized representative. It outlines the responsibilities and rights of both the applicant and the representative, including the ability to assist in applications, attend interviews, and access information related to the Medi-Cal benefits process. The authorization lasts for one year unless revoked earlier.

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Click ‘Get Form’ to open the mc 306 sp form in the editor.
Begin by filling out Section I, where you will enter your name, case number (optional), and date. Clearly state the name of the authorized representative and their organization.
Provide the complete address and phone number of your representative. This section allows them to assist you in your Medi-Cal application process.
Review the responsibilities listed for both you and your representative. Ensure you understand what is required from each party.
Sign and date the form at the bottom of Section I, confirming your authorization for the designated representative.
In Section II, if applicable, have your authorized representative complete their information, including their signature and date.

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