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Filing a Grievance or Appeal

Filing a Grievance or Appeal

Grievance Forms

Online English Grievance Form

Online English Appeal Form

Online Spanish Grievance Form

Online Spanish Appeal Form

English Medi-Cal Grievance Form

Arabic Medi-Cal Grievance Form

Spanish Medi-Cal Grievance Form

Vietnamese Medi-Cal Grievance Form

Tagalog Medi-Cal Grievance Form

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 - CMC

Your Rights - Medi-Cal

Your Rights - Medi-Cal (Spanish)

Your Rights - Medi-Cal (Arabic)

Your Rights - Medi-Cal (Vietnamese)

Your Rigths - Medi-Cal (Tagalog)