CenCal Health - Forms -Secure File Transfer for Community Supports

Secure File Transfer for Community Supports

Send files securely to CenCal’s Health Services CS Department

* Required fields are marked with asterisk

SENDER INFORMATION

Your Name*

Your Email*

Your Call Back Number*

MEMBER INFORMATION

Medi-Cal ID#/CIN:

Member Last Name*

Authorization Number*

< Please indicate below which type of Community Support Service the documents are associated to >

Type:

< Please check URGENT ONLY if delaying member's treatment will affect life or limb >

Urgent

Message

*Note: Please do not upload any files with special characters in the file name (including quotation marks " " or ? ect.), as this will cause errors saving to our internal directories and make the file transfer fail*

Attached*

Drop files here, or browse to attach files

Confirmation Required

Are you sure you want to remove the selected file?

For assistance with this Form, please call Health Services Community Supports Department at (805) 562-1698 or contact us on our website www.cencalhealth.org.

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