If you have questions or need help with your health care, please call our Customer Service Department at:
1-714-246-85001-888-587-8088 (toll free)
24 hours a day, 7 days a week.
Members with hearing or speech impairments can call the TDD/TTY line at 1-800-735-2929.
We also provide interpreter services at no cost to our members.
We have staff who speak your language.
Tenemos personal que habla su idioma.
Chúng tôi có nhân viên nói cùng ngôn ngữ với quý vị
ما پرسنلی را در استخدام داریم که به زبان شما تکلم می کنند.
여러분의 언어를 하는 직원이 있습니다.
ما پرسنلی را در استخدام داریم که به زبان شما تکلم می کنند
We want to make it easy for you to find the forms you need. If you don't see the form you are looking for, or if you are not sure which one you need, please call CalOptima's Customer Service Department at the number to the right side of the screen. We are here to help you.
Authorization for Use or Disclosure of Protected Health Information (PHI)
Authorization for Use or Disclosure of Protected Health Information to Family Member or Friend Involved in Member Care
Individual Request for Protected Health Information (PHI) Access
Medical Release Form
Member Complaint Form
Member Request to Amend PHI
Request for an Accounting of Disclosures
Request for Restriction on Manner/Method of Confidential Communications
Request for Restriction on Use and Disclosure of Protected Health Information (PHI)
Statement Of Disagreement Request To Include Amendment Request And Denial With Future Disclosures
Suspected Fraud or Abuse Referral Form
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