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MC-350(A-12b(5))Optional

Additional Medical Service Providers Attachment to Petition for Approval of Compromise of Claim or Action or Disposition of Proceeds of Judgment

California · Judicial Council of California · Effective January 1, 2021

This form is an attachment used when asking the court to approve how money from a claim or judgment will be used for a minor or person with a disability. It asks for details about medical service providers who need to be paid or who have a right to payment from the money.

The court describes it as: Gives you more room in filling out form MC-350 to list medical service providers who need to be paid for their services to the minor or person with a disability you are acting for. This is always attached to form MC-350.

Open the official PDFfrom Judicial Council of California

Where this fits in a case

Start a case

Stage: Start a case

This form is used when filing form MC-350 to ask the court to approve settling a claim or using money from a judgment for a minor or person with a disability. It is used to list medical providers who are owed money or who were paid using the settlement or judgment money.

Usually filed by the person starting the case.

Common questions

What is this form for?
This form is an attachment to form MC-350. It helps list medical service providers who need to be paid from the money being approved by the court for a minor or person with a disability.
Do I have to use this form?
You must use this form if you are using form MC-350 and need to provide information about medical service providers who have liens or who were paid from the proceeds.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2021.

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