形式：DHCS 6000
形式：DHCS 6000
- DHCS 6002 – Initial Treatment Provider Application
- DHCS 6011-1112 直接提供者麻醉品治療計畫 - 酒精和藥物(Excel)
選項：
說明 - 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 (修正案)07/2025) 醫療服務供應商協議
- DHCS 6209 (12/14) – Medi-Cal 補充變更
- DHCS 6217 (11/21) – 繼承人責任及連帶責任協議
- DHCS 6236（修訂版）03/24）－取得受保護健康資訊的請求－個人請求
- 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