表格：DHCS 4000
DHCS 4000 A (10/10) – GHPP 资格认定申请
DHCS 4000 B (10/10) – GHPP 初始/年度收入核实
DHCS 4001 – Family PACT Program追溯资格认证 (REC)
DHCS 4001SP – Family PACT Program Retroactive Eligibility Certification (REC-Spanish)
DHCS 4014 (06/07) – California Children’s Services Medical Report
DHCS 4015 U (01/08) – 患者病史交易
DHCS 4026 – 附带医疗服务认证表 – 医疗保健从业人员客户评估
DHCS 4027 (04/26) - CCS 医疗/治疗计划服务同意书
DHCS 4087 – 主索引拒绝通知
DHCS 4098 (09/07) – CCS Medical Therapy Program Therapy Assessment Plan
DHCS 4431 – Telecommunications Provider and Biller Application/Agreement
DHCS 4461 客户资格认证 (CEC)
DHCS 4461SP 客户资格认证（CEC-西班牙语）
DHCS 4469 家庭 PACT 提供者协议（10-25 版）
DHCS 4470 家庭 PACT 从业者参与协议
DHCS 4475 多地点声明现场验证员（修订版）01-26）
DHCS 4480 (06/25) - 确定加州儿童服务计划资格的申请表
Alt: Spanish
DHCS 4488 (09/15) – New Referral CCS/GHPP Client Service Authorization Request (SAR)
DHCS 4489 (09/15) – CCS/GHPP Discharge Planning Service Authorization Request (SAR)
DHCS 4490 – Health Assessment Provider Application
DHCS 4491 – Health Assessment Provider Agreement
DHCS 4492 – Medical Record Review Tool
DHCS 4493 – Facility Review Tool Scoring Instructions
DHCS 4494 – Facility Review Scoring Summary Sheet
DHCS 4502 – Laboratory Provider Application
DHCS 4503 – Laboratory Provider Program Agreement
DHCS 4504 – Report of Distribution
DHCS 4505 (09/07) – CCS Medical Therapy Plan
DHCS 4507 (01/08) – CCS Special Care Center Directory Update Form
DHCS 4509 (09/15) – Established CCS/GHPP Client Service Authorization Request (SAR)
DHCS 4510 (05/13) – CMS Net Medical Therapy Program MTP Therapist Table
DHCS 4512 (05/13) – DHCS Computer Files Release/Access of MC Program Confidential Oath
DHCS 4516 (09/15) – CCS Client Dental and Orthodontic Service Authorization Request