DHCS has received reports that scammers are calling eligible Medi-Cal members to renew their medical coverage. Medi-Cal will never require payment in the application or renewal process. Click here to learn more.
If you would like to file a grievance with CalViva Health, click here.
Confidential Communications Request Forms
View the request forms here.
Required if you would like to have CalViva Health send any communication that has protected health information (PHI) directly to you instead of the primary account holder.
Authorization for Disclosure of PHI
Required for the use or disclosure of your protected health information (PHI) beyond uses and disclosures for payment, treatment or health care operations.
Download the Authorization for Disclosure of PHI (English).
Health Information Form
The Health Information Form will help your Primacy Care Physician (PCP) identify any extra needs or services you may require. Please share this form with your PCP upon completion.
Download the Health Information Form (English).