فرم ارجاع اعضای مدیریت مراقبت پیشرفته جوانان (سن 20 سال و کمتر)

مدیریت مراقبت پیشرفته (ECM) is a no-cost benefit for eligible Medi-Cal members.

ECM helps children and youth with serious health, mental health or social challenges. This form helps us decide if the member may qualify. It does not mean you will get services.

Participation is your choice. Your information is private and only shared with staff helping with your care.

If you need help filling out this form, call us at 800-700-3874.

ما به زبان شما کمک رایگان ارائه می‌دهیم. تماس بگیرید 800-700-3874 (TTY: 800-735-2929 یا 711).