logo
  • Members
    • Member Access
    • Member Services
    • Health Education
    • Member Communications
    • Clinical Guidelines
    • GRIEVANCE FORM
    • Behavioral Health
    • Member Community Resources
    • Review Process for Requested Services
  • Providers
    • Provider Services
    • Provider Access
    • Health Education Documents
    • HEDIS
    • COVID-19 Postcards
    • Staying Healthy Tools
    • Provider Alerts
    • Provider Newsletters
    • ADA/Anti-Fraud
    • Cultural Competency & Linguistic Resources
    • Provider Community Resources
    • New Provider Orientation
    • Review Process for Requested Services
  • CHG Plans
    • Medi-Cal
    • CommuniCare Advantage Cal MediConnect Plan
  • About
    • About CHG
    • Affiliations
    • Mission/Vision Statement
    • Message From CEO
    • Compliance
    • FDR Portal
    • Careers
logo
icon-menu
icon-search
  • Members
    icon-chevron-right
  • Providers
    icon-chevron-right
  • CHG Plans
    icon-chevron-right
  • About
    icon-chevron-right
  • Find A Provider
icon-chevron-left
icon-search
  • icon-check English
  • español
Font Size
  • A
  • A
  • A
Find A Provider
img alt
  • Medi-Cal
    • Formulary
    • Medi-Cal Forms
    • Other Documents
  • CommuniCare Advantage Cal MediConnect Plan
    • 2019 Plan Information
      • How to Enroll or Disenroll
      • How to See a Doctor
      • Formulary & Prescription
      • Drug Transition Policy
      • How to File a Part C Grievance or Appeal
      • Member Rights and Responsibilities
      • Out-of-Network Coverage Rules
    • 2020 Plan Information
      • How to Enroll or Disenroll
      • How to See a Doctor
      • Formulary & Prescription
      • Drug Transition Policy
      • How to File a Part C Grievance or Appeal
      • Member Rights and Responsibilities
      • Out-of-Network Coverage Rules

Medi-Cal Forms

  • Rights and Responsibilities 
  • Filing a Grievance
  • Evidence of Coverage (Member Handbook)
  • Medication Request Form
  • Appointment of Representative Form (English)
  • Appointment of Representative Form (Spanish)
  • CHG Medi-Cal Customer Service (800) 224-7766
  • CHG Cal MediConnect Customer Service (888) 244-4430
  • TTY(855) 266-4584
  • Email info@chgsd.com
  • © Copyright 2020
  • Privacy Practice
  • Credits
  • Non-Discrimination Notice
  • Online Grievance Form