How to File a Grievance or Appeal
How to File a Grievance or Appeal
GRIEVANCE FORMS
GRIEVANCE FORM - English (Online)
GRIEVANCE FORM - Spanish (Online)
APPEAL FORM - English (Online)
APPEAL FORM - Spanish (Online)
GRIEVANCE/APPEAL FORM - English (Hard Copy)
GRIEVANCE/APPEAL FORM - Arabic ( Hard Copy)
GRIEVANCE/APPEAL FORM - Spanish (Hard Copy)
GRIEVANCE/APPEAL FORM - Vietnamese (Hard Copy)
GRIEVANCE/APPEAL FORM - Tagalog (Hard Copy)
GRIEVANCE/APPEAL FORM - Chinese (Hard Copy)
GRIEVANCE/APPEAL FORM - Farsi (Hard Copy)
CMS Part C Coverage Reconsideration Request Form
CMS Part D Coverage Determination Request Form
Appointment of Representative Form (English)
Appointment of Representative Form (Spanish)
Your Rights - Medi-Cal (Spanish)
Your Rights - Medi-cal (Arabic)
Your Rights - Medi-Cal (Vietnamese)
Your Rights - Medi-Cal (Tagalog)
Your Rigths - Medi-Cal (Chinese)
Your Rights - Medi-cal (Farsi)