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Healthy Kids forms and documents

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Name English Español Tiếng Việt 中文 Tagalog
Authorized Representative Form Link Link Link Link Link
Denti-Cal Providers Link
Grievance and Appeals Form Link Link Link Link Link
Health Information Form for New Members Link Link Link Link Link
Healthy Kids Evidence of Coverage (EOC) Link Link
Healthy Kids Formulary Link Link
Healthy Kids Glossary of Health Coverage and Medical Terms Link Link
Healthy Kids Liberty Dental Provider Directory Link Link
Healthy Kids Provider Directory Link Link
Healthy Kids Summary of Benefits (SBC) Link Link
Language Assistance Services Link Link Link Link Link
Medicare / Medi-Cal - Update Your Information Link Link Link Link Link
Member Rights and Responsibilities Link Link Link Link Link
Notice of Nondiscrimination Link Link Link Link Link
Notice of Privacy Practices Link Link Link Link Link
Staying Healthy Assessment - 0-6 Months Link Link Link Link Link
Staying Healthy Assessment - 7-12 Months Link Link Link Link Link
Staying Healthy Assessment - 1-2 Years Link Link Link Link Link
Staying Healthy Assessment - 3-4 Years Link Link Link Link Link
Staying Healthy Assessment - 5-8 Years Link Link Link Link Link
Staying Healthy Assessment - 9-11 Years Link Link Link Link Link
Staying Healthy Assessment - 12-17 Years Link Link Link Link Link
Staying Healthy Assessment - Behavioral Risk Topics At-A-Glance Link
Staying Healthy Assessment - Pediatric Questions by Age Group Link
Vision Service Plan (VSP) Doctor Directory Link Link Link Link Link