Disability Specialist Contact Form

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The Department of Managed Health Care (DMHC) is committed to providing you with accessible communication. Please use the form below to contact the DMHC Disability Specialist with questions, request materials from the DMHC in an alternate format, or provide the DMHC with feedback.

Skip to Request Alternate Format Form

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If you would like to receive a response to your comments, please complete the following:

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Alternate Format Request Form

To request an alternate format document, please provide the following information. If you would like to request multiple alternate formats, please use the "Additional Details" field to provide details of your request.

Document Title:
Link to document or webpage:
Alternative Format:
If other, please specify format:
Communication Assistance:
If other, please specify format:
Additional Details:

Please provide your contact information below -
Your Name:
E-mail Address: 
Daytime Phone:
Mailing Address:
City:
State:
Zip Code:




Need Help with Your Health Plan?

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1-888-466-2219

or submit an Independent Medical Review/Complaint Form

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