Forms Library

Behavioral Health

To learn more about Behavioral Health, visit the Mental Health Services & Behavioral Health Treatment (ABA) Services Webpage.

Pharmacy

Pharmacy Forms and downloads

Radiology

To learn more about Radiology, visit the Radiology Benefit Manager Webpage.

SNF Clinical Request Form

View the SNF Clinical Request Form PDF

6 Month Progress Report

ABA Recommendation Form

Functional Behavioral Assessment

ABA Service Hour Log

Member Education Form

Behavioral Health Care Coordination Request Form

DHCS Transition of Care form

PCP Psychological Evaluation Request

For more information about joining our network, visit the Join Our Network Webpage.

For claims forms, visit the Claims Webpage.

For health materials, visit the Patient Education Materials Webpage.

Member Rights and Responsibilities – English

Member Rights and Responsibilities – Spanish

Member Grievance Form SBHI & SLOHI – English

Member Grievance Form SBHI & SLOHI – Spanish

Member Grievance Form HF,HK,PP2,IHSS – English

Member Grievance Form HF,HK,PP2,IHSS – Spanish

Resources for disabled and Special Needs

Community Resources

California Minor Consent Laws

For more information, visit the Cultural & Linguistic Resources Webpage.

Fraud and Abuse Reporting for more info, visit the “Do You Suspect Fraud?” Webpage.

Fraud by a Provider

Fraud by a Member (English)

Fraud by a Member (Spanish)

CenCal Health strives to provide Cultural Competency and Health Literacy tools to our providers to improve provider-patient communication.  These tools provide appropriate health care and services for our members regardless of race, color, national origin, creed, ancestry, religion, language, age, marital status, sex, sexual orientation, gender identity, health status, physical or mental disability, or identification with any other persons or groups.

Visit the Cultural Competency & Health Literacy Webpage to learn more!

Community Supports-Medically Tailored Meals Information and Referral form

Recuperative Care Information and Referral Form

Community Health Worker Quick Reference Guide

Community Health Worker Recommendation Form

Doula Benefit Quick Reference Guide

Doula Service Recommendation Form

Additional Postpartum Visit Doula Recommendation Form