形式：DHCS 4000
DHCS 4000 A (10/10) – GHPP 資格認定申請
DHCS 4000 B (10/10) – GHPP 初始/年度收入核實
DHCS 4001 – Family PACT Program追溯資格認證 (REC)
DHCS 4001SP – Family PACT Program追溯資格認證（REC-西班牙語）
DHCS 4014 (06/07) – California Children's Services醫療報告
DHCS 4015 U (01/08) – 病患病史交易
DHCS 4026 – 附帶醫療服務認證表 – 醫療保健從業人員客戶評估
DHCS 4027 (04/26) - CCS 醫療/治療計劃服務同意書
DHCS 4087 – 主索引拒絕通知
DHCS 4098 (09/07) – CCS醫療治療Program治療評估計劃
DHCS 4431 – 電信服務供應商和計費方申請/協議
DHCS 4461 客戶資格認證（CEC）
DHCS 4461SP 客戶資格認證（CEC-西班牙語）
DHCS 4469 Family PACT 服務提供者協議 (rev.10-25)
DHCS 4470 家庭協定執業者參與協議
DHCS 4475 多地點聲明現場驗證員（修訂版）01-26）
DHCS 4480 (06/25) - 確定加州兒童服務計劃資格的申請表
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