Becoming a CHDP Provider

For more information see the CHDP Provider Manual.

Health Assessment Providers

Health Assessment providers apply to the local CHDP program in each local jurisdiction in which they wish to render services. 

Providers submit:

• California Child Health and Disability (CHDP) Program Assessment Provider Application (DHCS 4490) and
• CHDP Health Assessment Provider Program Agreement (DHCS 4491)  

Licensed Primary Care Clinics  

Licensed Primary Care Clinics may apply to participate in the CHDP program simultaneously with the application to be licensed.  For more information refer to:

• How to Apply For Specified Health Programs  

Clinical Laboratory Providers

Clinical laboratory providers apply to Children’s Medical Services Branch, Provider Services Unit (PSU).  For more information  contact the PSU at (916) 322-8702.  The following application forms must be completed by clinical laboratory applicants:

• CHDP Laboratory Provider Application (DHCS 4502)
• CHDP Laboratory Provider Program Agreement (DHCS 4503)

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