表格：DHCS 6000
表格：DHCS 6000
- DHCS 6002 – Initial Treatment Provider Application
- DHCS 6011-1112 直接提供者麻醉品治疗计划 - 酒精和毒品(Excel)
备选：
说明 - 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（修订版）07/2025) Medi-Cal 提供商协议
- DHCS 6209 (12/14) – Medi-Cal 补充变更
- DHCS 6217 (11/21) – 继承人责任及连带责任协议
- DHCS 6236（修订版）03/24）——获取受保护健康信息的请求——个人请求
- DHCS 6236 (Rev. 03/24) Spanish – Autorización Para La Divulgación De Información Médica Protegida
- DHCS 6249 (08/19) – 指定代理人 – Estate Recovery
- DHCS 6251 (04/20) – Estate Recovery Questionnaire (Notice of Death)
- DHCS 6251 (04/20) – Estate Recovery Questionnaire (Notice of Death) – Spanish