California health care services 2026

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The document is a Medical Report for Medi-Cal or MCAP Postpartum Care Extension from the California Department of Health Care Services. It includes sections for patient information, medical release authorization, and details regarding maternal mental health conditions. The report aims to determine eligibility for continued Medi-Cal or MCAP benefits based on diagnoses related to postpartum mental health within a specified timeframe.

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Click ‘Get Form’ to open the California Health Care Services document in the editor.
Begin by filling out Section I, which includes patient/client information. Enter the name, birth date, and Social Security or Medi-Cal number accurately.
In the authorization section, specify the licensed physician or certified psychologist's name and their clinic. Ensure you understand that this authorization is valid for one year.
Proceed to Section II to indicate if the individual has been diagnosed with a maternal mental health condition. Select 'Yes' or 'No' and provide the onset date if applicable.
Finally, ensure that the treating health care provider signs and dates the form, providing their printed name, title/specialty, phone number, and mailing address.

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2020	4.9 Satisfied (29 Votes)
2007	4.9 Satisfied (55 Votes)

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