Primary Care Provider (PCP) Selection Form - Gold Coast Health Plan - goldcoasthealthplan: Fill out & sign online

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Click ‘Get Form’ to open the Primary Care Provider (PCP) Selection Form in the editor.
Begin by locating your desired doctor or clinic in the provided directory. Once you find them, write their name in the designated space labeled 'Print Physician or Clinic Name'.
Next, identify the four-digit ID number that appears in bold next to the physician's name. Enter this number in the space marked 'Physician or Clinic ID number (4 digit)'. Remember, all doctors within the same clinic share this ID.
Fill out your personal information including your Date of Birth and Member Name in the respective fields.
Finally, sign and date the form at the bottom to confirm your selection before mailing it back using the prepaid envelope provided.

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How do I change my on Gold Coast Health Plan?

There are three ways to make this change: Call Member Services at 1-888-301-1228/TTY 1-888-310-7347 to request the change. Complete a Selection Form and mail it, fax it or drop it off at GCHPs office in Camarillo.

How do I change my on my LA Care health plan?

To change your , call L.A. Care Member Services at 1-888-839-9909 (TTY: 711). You may also request to change your by logging onto the L.A. Care Connect member portal.

What is selection?

GCHP is your health plan in Ventura County after you qualify for Medi-Cal. You will be automatically enrolled in GCHP one to two months after you are eligible. GCHP will send you a new member packet. GCHP covers most Medi-Cal services.

Is Gold Coast Health Plan the same as Medi-Cal?

Heres a three-step plan for switching primary care providers: Step 1: Find a New Physician. You dont want to leave your current primary care provider until you have found a new physician. Step 2: Make Sure You Have Your Medical Records. Step 3: Connect with Your New Office. Get Help Switching Primary Care Providers.

How do I change my with Mass Health?

If you are a Primary Care Clinician (PCC) plan member and want to change your , call us at 1-800-841-2900 (TDD/TTY:711).

Primary Care Provider (PCP) Selection Form - Gold Coast Health Plan - goldcoasthealthplan 2026

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How to use or fill out Primary Care Provider (PCP) Selection Form - Gold Coast Health Plan - goldcoasthealthplan with our platform