Record Review California Form PDF Details

The California Form, or Standardized Utilization Review Plan, is an important part of the state's health care system. It helps to ensure that only medically necessary services and treatments are provided to patients across the state. All healthcare providers must adhere to these standards when submitting claims for reimbursement from payers and insurance companies in California. This post will provide a comprehensive review of what you need to know about completing the Record Review California form and how it can help improve your organization's financial performance.

QuestionAnswer
Form NameRecord Review California Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesca firearms record, record review firearms, record review california, scan firearms

Form Preview Example

 

 

CALIFORNIA DEPARTMENT OF JUSTICE

 

 

 

 

BUREAU OF FIREARMS

 

 

 

FIREARMS RECORD REVIEW

 

 

 

REQUEST FOR LIVE SCAN SERVICE

 

 

 

 

 

Please Type or Print

 

ORI: AB165

Type of Application:

Firearms Record Review

 

 

 

Reason forApplication:

 

 

Firearms Eligibility Denial

 

 

 

 

 

Agency Address:

 

 

 

 

California Department of Justice

 

 

 

Record Review Unit

 

 

07041

 

Name

 

 

 

Mail Code (five digit code assigned by DOJ

 

P.O. Box 903417

 

 

Record Review Unit

 

Address

 

 

 

Contact Name

 

Sacramento, CA 94203-4170

 

(916) 227-3835

 

City

State

Zip Code

 

Contact Telephone No.

 

Name of Applicant:

 

 

 

 

 

 

Last

 

First

M

Alias:

 

Last

 

 

First

 

Date of Birth:

 

 

Sex: EZI Male

Female

Billing No:

Height:

Weight:

 

Eye Color:

Hair Color:_______

Place of Birth:

Home Address:

 

 

 

California Drivers License No:

Street or P.O. Box

 

 

 

Social Security Number:

 

 

 

 

 

City

 

State

Zp Code

Daytime Telephone Number:

 

 

 

M

Applicant to pay fees

Level of Service:

DOJ only

If Resubmission, list Original ATI No:_______________________

Live Scan Transaction Completed by:

Date:

Name of Operator

 

Transmitting Agency:

Amount Collected:

ATI Number:

Terminal ID:

 

ORIGINAL - Live Scan Operator

SECOND COPY -Applicant

BCIJ/BOF 8016 FRR (Revised 11/08)

Instructions for Completing

FIREARMS RECORD REVIEW REQUEST FOR LIVE SCAN SERVICE

California Penal Code sections 11120 through 11127, and 12077.5 afford you an opportunity to obtain a copy of your record, if any, contained in the files of the California Department of Justice and refute any erroneous or inaccurate information contain therein.

Beginning with live scan transactions submitted afterApril 6,2006, the Department of Justice (DOJ) will only mail responses to you.

You may use the information you receive to answer questions regarding past criminal history, firearms eligibility, or to complete an application or questionnaire. However, no person or agency may require you to obtain a copy of your record or to furnish the inforamation for any purpose, including immigration, visa, employment, licensing, or certification. (See California Penal Code Sections 11125 and 12077.5(g).)

GUIDELINES FOR COMPLETING THE “REQUEST FOR LIVESCAN SERVICE” FOR (BCll/BOF 8016 FRR)

CATEGORY

Type of Application:

Reason forApplication:

Name of Applicant & Personal Descriptors:

Applicant Address:

Daytime Telephone Number:

INSTRUCTIONS

Verify “Firearms Record Review” appears.

Write a brief explanation of why you need this information.

Enter your full name, any known alias, date of birth, sex, heigth, weight, eye & hair color, place of birth, social security number and California driver’s license number.

Enter your home address.

Enter the telephone number, including area code, where you can be reached between 8 am. and 5 p.m.

COMMENTS

This is a mandatory field and must be completed.

Example reason, “Firearms Eligibility Denial”.

Name, date of birth, and sex are mandatory fields and must be pro- vided. All others are optional.

This is a mandatory field and must be completed.

A telephone number is useful in helping to resolve problems which could result in a delay in processing your request.

AFTER COMPLETING THE “REQUEST FOR LIVE SCAN SERVICE” FORM

*Check your local telephone directory or contact your local Police Department or Sheriff’s Office for businesses or local law enforcement agencies that offer “Live Scan” fingerprinting services, the fee charged by the business/agency for the Live Scan service, and the types of payment accepted. You can also view a current listing of Live Scan sites offering electronic fingerprinting services on the Attorney General’s website at: http://ag.ca.gov/fingerprints/publications/contact. htm.

*Go to the Live Scan business/agency of your choice and have your fingerprints taken. Your total cost will be $25 plus the fingerprint rolling fee charged fortaking yourfingerprints. Please ensure that any private fingerprinting service you select is certified by the California Department of Justice.

*If you have questions about completing the “Request for Live Scan Service” form (BCI 1/BOF 8016 FRR), contact the Record Review Unit at (916) 227-3835.

*For inquiries regarding the status of your criminal history record review, please contact the Record Review Unit at

(916)227-3849.

*For inquiries regarding the status of your firearm record review (e.g., restraining order, mental health record,

etc.), please contact the Firearms Record Review Unit at (916) 227-1375.

BCII/BOF 8016 FRR (Revised 11/08)

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Learn how to fill out scan firearms stage 1

2. Once your current task is complete, take the next step – fill out all of these fields - Name of Operator, Transmitting Agency, ATI Number, Amount Collected, Terminal ID, BCIJBOF FRR Revised, ORIGINAL Live Scan Operator, and SECOND COPY Applicant with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Terminal ID, ATI Number, and Name of Operator in scan firearms

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