양식: DHCS 6000
양식: DHCS 6000
- DHCS 6002 – Initial Treatment Provider Application
- DHCS 6011-1112 직접 제공자 마약 치료 프로그램 - 알코올 및 약물 (엑셀)
Alt:
지침 - DHCS 6012-1112 Direct Provider Narcotic Treatment Program – Perinatal (Excel)
Alt:
Instructions - DHCS 6040 – Initial Application for Certification
- DHCS 6041 – Initial Application for Existing Certified Programs To Obtain Initial Certification for New Program
- DHCS 6042 – Application for Certification Amendment
- DHCS 6043 – Application for Certification Renewal
- DHCS 6045 – Detoxification Observation – Vital Signs Check Log
- DHCS 6046 – Detoxification Observation – Physical Check Log
- DHCS 6047 – Application for Existing Licensee to Obtain Initial Licensure for New Facility
- DHCS 6048 – Consent to Electronic Service Agreement
- DHCS 6204 (02/17) – Medi-Cal Provider Application
- DHCS 6207 (2/17) – Medi-Cal Disclosure Statement
- DHCS 6208(Rev. 07/2025) 메디칼 제공자 동의서
- DHCS 6209 (12/14) – 메디칼 보충 프로그램 변경 사항
- DHCS 6217 (11/21) – 연대책임 계약을 통한 승계책임
- DHCS 6236 (개정판) 03/24) – 개인 건강 정보 접근 요청
- DHCS 6236 (Rev. 03/24) Spanish – Autorización Para La Divulgación De Información Médica Protegida
- DHCS 6249 (08/19) – 상속재산 회수를 위한 대리인 임명
- DHCS 6251 (04/20) – Estate Recovery Questionnaire (Notice of Death)
- DHCS 6251 (04/20) – Estate Recovery Questionnaire (Notice of Death) – Spanish