Mga Form ng Provider
Makikita ang mga karagdagang form sa website ng Medi-Cal Provider.
Paglahok ng Kliyente
Application to Determine CCS Eligibility (English) – DHCS 4480
Tingnan ang webpage ng California Children's Services Forms para sa availability sa iba pang mga wika.
Paglahok ng Provider
- Communication Disorder Center Application – DHCS 4482
- Outpatient Infant Hearing Screening Provider Application – DHCS 4481
Humihiling ng Mga Serbisyo
- CCS Client Dental and Orthodontic Service Authorization Request – DHCS 4516
- CCS/GHPP Discharge Planning Service Authorization Request (SAR) – DHCS 4489 (7/07)
- Established CCS/GHPP Client Service Authorization Request (SAR) – DHCS 4509
- New Referral CCS/GHPP Client Service Authorization Request (SAR) – DHCS 4488 (7/07)