PR022 - Notice to Department of Health
San Luis Obispo Superior Court · Civil, Family, Probate, Small Claims
Verified current as of September 10, 2026
Used by the personal representative of a decedent's estate to formally notify the Department of Health Care Services that the decedent (or a predeceased spouse) may have received Medi-Cal benefits, as part of probate administration.
This form must be printed and filled by hand, or opened in Adobe Acrobat.