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- PM 330 _1-99_ Eng-SP - Medi-Cal
(Instructions for use of Alternative Final Paragraphs: Use the first paragraph below except in the case of premature delivery or emergency abdominal surgery when the sterilization is performed less than 30 days after the date of the individual’s signature on the consent form
- CONSENT FORM PM 330 - IEHP
(2) This sterilization was performed less than 30 days but more than 72 hours after the date of the individual’s signature on this consent form because of the following circumstances (check applicable box below and fill in information requested )
- Human Sterilization and Informed Consent
The Department of Health Care Services (DHCS) Consent Form PM 330 (English PDF, Spanish PDF) is the only form approved by DHCS for certification of informed consent
- CA PM 330 1999-2026 - Fill and Sign Printable Template Online
The CA PM 330 is a consent form used in the State of California by individuals seeking sterilization This guide will provide you with clear and supportive instructions on how to accurately complete this form online, ensuring you understand each section and field
- CONSENT FORM PM 330 - Central California Alliance for Health
At least thirty days have passed between the date of the individual’s signature on this consent form and the date the sterilization was performed
- Sterilization (ster) - Medi-Cal
A completed consent form must accompany all claims for sterilization services This requirement extends to all providers, attending physicians or surgeons, assistant surgeons, anesthesiologists and facilities
- Forms and References
Member Appeal or Grievance Form - English (Community Health Plan of Imperial Valley (PDF) Member Appeal or Grievance Form - Spanish (Community Health Plan of Imperial Valley (PDF)
- State Human Care CONSENT FOR STERILIZATION - DHCS
(2) This sterilization was performed less than 30 days but more than 72 hours after the date of the individual's signature on this consent form because of the following circumstances (check applicable box and fill in information requested):
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