The Department of Health Care Services (DHCS) Sterilization Consent Form Update
| Date: | October 22, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan All Providers |
| Type: | Informational |
| Subject: | The Department of Health Care Services (DHCS) Sterilization Consent Form Update |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) Consent for Sterilization form DHCS 8649 is the only form accepted by DHCS for sterilization procedures. The DHCS 8649 form requirements are consistent with federal requirements and can also be found in California Code of Regulations, Title 22, Section 51305.4. The DHCS 8649 supersedes the previous sterilization consent form, PM 330, which will no longer be accepted by DHCS.
The DHCS 8649 form can be downloaded from the DHCS Sterilization Material web page. Instructions for completing the DHCS 8649 can be found in the Sterilization section of the appropriate Part 2 Medi-Cal Provider manual. The instructions must be followed exactly or the DHCS 8649 will be returned by DHCS and reimbursement delayed.
Please click the Consent for Sterilization link below:
https://www.dhcs.ca.gov/Pages/permanentbirthcontrol.aspx
For questions or assistance call the DHCS Telephone Service Center (TSC) at 1-800-541-5555.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
