California Department of Health Care Services Forms

This Form is used for conducting a health assessment for senior individuals in California to ensure they are staying healthy and receiving the necessary care and support.

This form is used for conducting a health assessment for adults in California who belong to the Hmong community. It helps in evaluating their overall health and identifying any potential health risks or issues.

This Form is used for the Staying Healthy Assessment for Seniors in California, specifically for the Hmong community.

This Form is used for Staying Healthy Assessment for children aged 1-2 years in California. (Spanish version)

This document is used for health evaluation of 3-4 year old children in California. It is available in both English and Spanish.

This Form is used for evaluating the health of children aged 9-11 in California. It is available in both English and Spanish.

This Form is used for completing a Staying Healthy Assessment for children aged 1-2 years in California. The form is available in the Korean language.

This form is used for the health evaluation of adults in California. It is available in both English and Spanish.

This form is used for evaluating the health of older adults in California. It is available in both English and Spanish.

This form is used for the Staying Healthy Assessment for children aged 3-4 years in California. It is specifically available in the Korean language.

This Form is used for conducting a Staying Healthy Assessment for children aged 5-8 years in California, and it is available in the Korean language.

This Form is used for completing a Staying Healthy Assessment for children aged 9-11 years in California. It is available in Korean language.

This form is used for conducting a Staying Healthy Assessment for children aged 1-2 years in California. The form is available in Chinese.

This form is used for conducting a Staying Healthy Assessment for children aged 3-4 years in California who are of Chinese descent. The assessment helps ensure the child's overall health and well-being.

This Form is used for the Staying Healthy Assessment for adults in California, available in Korean language.

This form is used to assess the health of children aged 5-8 years in California who speak Chinese. It helps in promoting their overall well-being and ensuring they stay healthy.

This form is used for the Staying Healthy Assessment for senior individuals in California who speak Korean.

This form is used for conducting a Staying Healthy Assessment for children aged 9-11 years in California, specifically for Chinese-speaking individuals. It helps to assess the overall health and well-being of children in this age group.

This Form is used for conducting a health assessment for adults in California who speak Chinese. It helps to ensure that individuals receive appropriate healthcare services and stay healthy.

This document is a Staying Healthy Assessment form for seniors in California, specifically for the Chinese community. It is used to assess the health status of senior individuals and gather information for healthcare purposes.

This form is used for conducting a Staying Healthy Assessment for children aged 1-2 years in California. The form is available in both English and Tagalog languages.

This Form is used for conducting the Staying Healthy Assessment for children aged 3-4 years in California. It is available in both English and Tagalog languages.

This form is used for conducting a Staying Healthy Assessment for children between the ages of 5 and 8 in California. The form is available in both English and Tagalog languages.

This form is used for conducting a Staying Healthy Assessment for children between the ages of 9-11 in California. It is available in both English and Tagalog languages.

This form is used for keeping a monthly tally of patients' rights denials in California. It helps to track and record instances where patients' rights have been denied in healthcare facilities.

This form is used for requesting authorization for client services under the California Children's Services (CCS) or Genetically Handicapped Persons Program (GHPP).

This form is used for requesting client service authorization for the California Children's Services (CCS) and Genetic Handicap Program (GHPP).

This form is used for requesting dental and orthodontic services through the California Children's Services (CCS) program. It is a client service authorization request (SAR) form.

This form is used for providing additional information for Medi-Cal child applicants under the age of 18 in California.

This Form is used for applying for CalFresh (food stamps), cash aid, and/or Medi-Cal/Health Care programs in California. It is for individuals who need assistance with their basic needs or healthcare expenses.

This form is used for conducting a Staying Healthy Assessment for infants aged 0-6 months in California. It helps assess the overall health and development of infants in the state.

This form is used to assess the health of infants aged 0-6 months in California. It is available in Arabic language.

This form is used for conducting a Staying Healthy Assessment for infants aged 0-6 months in California. The form is available in Armenian.

This form is used for conducting a staying healthy assessment for infants aged 0 to 6 months in California. The form is available in Chinese language.

This form is used for conducting a Staying Healthy Assessment for infants aged 0-6 months in California. The form is available in Korean.

This document is a form used in California to assess the health status of infants aged 0-6 months. It is available in the Russian language.

This form is used for a Staying Healthy Assessment for infants aged 0-6 months in California, and it is available in Vietnamese language.

This Form is used for conducting a health assessment of infants aged 7-12 months in California. The form is available in Arabic.