County Claim Form
County Claim Form - Electronic and facsimile filings will not be accepted. Executive officer, board of supervisors attention: Return the original in person or us mail to: Web to file a claim, please complete a claim form. Check prior authorization requirements by cpt code. Clerk of the board of supervisors 3.2 mb) as required by california government code sections 905 and 915. Fill out claim as indicated; Attach any bills for medical treatment and expenses and any estimates or bills for personal property damage to the completed form. You may print, sign and mail, or personally present to the address below.
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Electronic And Facsimile Filings Will Not Be Accepted.
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Check prior authorization requirements by cpt code. Web claims must be filed at the following location: The best legal forms website, free for all! The claim form must be accurately completed and signed.
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