Forms: DHCS 5000
- DHCS 5018 – Order Form
- DHCS 5021 – User Authorization
- DHCS 5023 – Media Loan Request
- DHCS 5024 – Consent for the Release of Confidential Information
- DHCS 5050 – Staff and Health Care Practitioner (HCP) Information
- DHCS 5054 – Notice of Inspection of Confidential Records
- DHCS 5077 – Health Screening Report
- DHCS 5078 – Centrally Stored Medication and Destruction Record
- DHCS 5079 – Incident, Injury or Death Report
- DHCS 5080 – Personal Rights – Alcohol Recovery and Drug Treatment Facilities
- DHCS 5080 SP – Derechos Personales – Facilidades de Recuperación y Tratamiento
- DHCS 5082 – Program Director Information
- DHCS 5083 – Administrative Organization – Corporation, Nonprofit Corporation Limited Liability Company, General Partnership or Limited Partnership
- DHCS 5084 – Administrative Organization – Public Agency or Sole Proprietor
- DHCS 5085 – Administrative Responsibility
- DHCS 5086 – Schedule of Recovery and Treatment Services
- DHCS 5099 – CalOMS – ADP 100177 CalOMS ITWS County-Direct Provider Approver
- DHCS 5100 – CalOMS – ADP 100178 CalOMS ITWS Vendor Approver
- DHCS 5101 – CalOMS – ADP 100179 CalOMS ITWS Internal Employee Approver
- DHCS 5102 – CalOMS – ADP 100180 CalOMS ITWS User Cancellation
- DHCS 5103 – Client Health Questionnaire and Initial Screening Questions
- DHCS 5103 SP – Cuestionario de Salud y Preguntas Iniciales de Evaluación del Cliente
- DHCS 5104 – Outpatient Fire Clearance
- DHCS 5111 – Sole Proprietor Application
- DHCS 5115 – Zoning Approval
- DHCS 5140 – Disclosure to DHCS
- DHCS 5255 – Supplemental Application Request for Additional Services
- DHCS 5256 – Health Care Practitioner Incidental Medical Services Acknowledgement
- DHCS 5999 – Request for License/Certification Extension