양식: DHCS 6000​​ 

• DHCS 6002 (06/16) – Initial Treatment Provider Application​​ 
• DHCS 6011-1112 직접 제공자 마약 치료 프로그램 - 알코올 및 약물 (엑셀)
  Alt:
  지침​​ 
• DHCS 6012-1112 직접 제공자 마약 치료 프로그램 - 주산기 (엑셀)
  Alt:
  지침
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• DHCS 6204 (01/13) – Medi-Cal Provider Application​​ 
  
• 
  DHCS 6207 (2/15) – Medi-Cal Disclosure Statement​​ 
  
  
• DHCS 6208(Rev. 07/2025) 메디칼 제공자 동의서​​ 
  
• DHCS 6209 (12/14) – Medi-Cal Supplemental Changes​​ 
  
• DHCS 6217 (11/21) – Successor Liability with Joint and Several Liability Agreement​​ 
  
• DHCS 6236 (Rev. 03/24) – Request for Access to Protected Health Information-Individual Request​​ 
• DHCS 6236 (Rev. 03/24) Spanish – Autorización Para La Divulgación De Información Médica Protegida​​ 
  
• DHCS 6249 (08/19) – Appointment of Representative – Estate Recovery​​ 
• DHCS 6251 (04/20) – Estate Recovery Questionnaire (Notice of Death)​​ 
• DHCS 6251 (04/20) – Estate Recovery Questionnaire (Notice of Death) – Spanish​​ 

양식 색인으로 돌아가기​​