California Department of Health Care Services Forms

This Form is used for assessing the health and well-being of infants between the ages of 7-12 months in California. It is available in Armenian language.

This form is used for assessing the health status of infants aged 7-12 months in California, specifically for Chinese-speaking residents.

This form is used for conducting a Staying Healthy Assessment for children aged 7-12 months in California. The form is specifically designed for individuals who speak the Hmong language.

This form is used for conducting a Staying Healthy Assessment for children aged 7-12 months in California. It is available in Korean.

This document is a form for assessing the health of children between the ages of 7-12 months in California. It is available in Russian language.

This form is used for the Staying Healthy Assessment for children aged 7-12 months in California. It is available in Tagalog.

This form is used for conducting a Staying Healthy Assessment for infants aged 7-12 months in California. It is available in the Vietnamese language.

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

This Form is used for the Staying Healthy Assessment for 3-4 year olds in California. It is available in Vietnamese.

This form is used for conducting a Staying Healthy Assessment for children aged 5-8 years in California. The form is available in Vietnamese.

This form is used for conducting a Staying Healthy Assessment for children aged 9-11 years in California. The form is available in the Vietnamese language.

This form is used for the Staying Healthy Assessment for individuals aged 12-17 in California. It is a tool to assess and promote the health and well-being of young people in the state.

This form is used for conducting a health assessment of children between the ages of 12 to 17 in the state of California. The assessment is available in Arabic language.

This form is used for conducting a Staying Healthy Assessment for children between the ages of 12-17 in California who speak Armenian. It helps assess their overall health and well-being.

This Form is used for conducting a Staying Healthy Assessment for 12-17 years old in California, specifically for Chinese-speaking individuals. It helps assess their overall health and well-being.

This form is used for conducting a Staying Healthy Assessment for children and teenagers aged 12-17 years in California. The form is available in Vietnamese.

This Form is used for conducting a Staying Healthy Assessment for individuals aged 12-17 years in California who speak the Hmong language.

This form is used for conducting a Staying Healthy Assessment for individuals aged 12-17 years in California. This specific version of the form is in Korean language.

This form is used for conducting a Staying Healthy Assessment for children aged 12-17 years in California. It is available in Russian language.

This Form is used for the Staying Healthy Assessment for children between the ages of 12-17 in California. It is available in Spanish.

This custom form, available in Vietnamese, is used for assessing the health status of adults in California and ensuring their well-being.

This form is used for conducting a Staying Healthy Assessment for senior individuals in California who speak Arabic.

This form is used for conducting a Staying Healthy Assessment for senior individuals in California who speak Vietnamese. It helps assess their health status and needs.

This Form is used for providing additional information about a property in California. It includes details such as the property's condition, history, and any improvements made.

This Form is used for submitting a monthly claim for reimbursement of treatment costs under the Short-Doyle/Medi-Cal program in California.

This form is used for claiming reimbursement for administrative costs related to specialty mental health services under the Medi-Cal program in California.

This form is used for filing a claim for reimbursement for Mental Health Medi-Cal Administrative Activities (MH MAA) on a quarterly basis in California.

This document is used for reporting the denial of rights, seclusion, and restraint incidents on a monthly basis in California.

This form is used for a county summary of rights denial in California. It provides information related to the denial of rights and procedures that counties must follow.

This form is used for requesting authorization to release a patient's medical information in the state of California.

This form is used for applying for voluntary admission of a mentally disabled person in California.

This form is used for requesting a waiver for mental health professional licensing in the state of California.

This form is used for providing information about the director's designee in the state of California.

This form is used for applying for certification of special treatment program services in California. It is required to be completed in order to participate in these programs.

This Form is used for former foster care youth in California to apply for Medi-Cal, a health insurance program.

This form is used for obtaining consent in California.