Forms

To view any of the forms and publications listed below, you will be leaving this website and the file is displayed in a new browser window.

California Department of Health Care Services

• Medi-Cal Application Enrollment Forms Page provides you with links and resources as well as application forms in multiple languages.
• Medi-Cal Publications provides informational brochures developed by the Department of Health Care Services.

Other Medi-Cal forms

• SAWS1.PDF Application For Cash Aid, Food Stamps, and/or Medi-Cal.
• MC 007.PDF Medi-Cal General Property Limitations form provides general information about property limitations and exemptions.
• MC 210 PS.PDF Property Supplement.
• MC 13.PDF Statement of Citizenship, Alienage, and Immigration Status (This form is not intended for U.S. Citizens or Nationals)
• DHCS0001.PDF U.S. Citizens and Nationals Applying for Medi-Cal is a fact sheet to answer questions about showing proof of citizenship and identity.
• MC 220.PDF Authorization for Release of Information.
• MC 013.PDF Information Notice - Important Information Regarding Your Appeal Rights.
• MC 13.PDF Statement of Citizenship, Alienage, and Immigration Status.