Provider Materials and Forms

Provider Materials and Forms


Cal MediConnect CPO Request & Determination Forms


Direct Contract Providers - CLAS Department Materials

Please allow 30 days for delivery of your order. You can request up to 5 copies of the items selected. All Health Education materials can be available in member's preferred language and/or in alternative formats (i.e. Braille, Large Print & Audio) upon request.


Critical Incident Reporting

A Critical Incident is any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the physical or mental health, safety or well-being, of a health plan client and/or his or her caregiver.

Please report all Critical Incidents by completing and submitting the Critical Incident Report Form below to Care1st. You may consult with Care1st’s Critical Incident Reporting (CIR) Team by calling: 323.889.6638 x3992.

Please remember to always respond fully and appropriately as the mandated reporter. While Care1st’s CIR Line can offer consultation, that department’s responsibility is limited to the tracking of such incidents. For example, it is still the mandated reporter’s responsibility to report and address incidents of elder or dependent adult abuse in accordance with Welfare and Institutions Code Section 15630. Contacting Care1st’s CIR Department does not take the place of contacting the appropriate authorities.