California Department of Health Care Services Forms

This form is used for County Approvers in California to certify their approval for certain documents or processes. It is an official certification form required by the California Department of Health Care Services (DHCS).

This form is used for applying to become a Narcotic Treatment Program in California.

This form is used for a Guarantor Agreement in the state of California. It outlines the responsibilities and obligations of a guarantor who agrees to be financially liable for a debtor if they are unable to fulfill their obligations.

This form is used for county recommendations in the state of California.

This form is used for obtaining letters of cooperation in the state of California.

This document is used for determining and identifying the geographical area in California.

This form is used for reporting the death of a patient in California. It is required by the California Department of Health Care Services (DHCS).

This form is used for hospitals in California to enter into an agreement with the Department of Health Care Services (DHCS).

This form is used for notifying the California Department of Health Care Services (DHCS) about changes in status regarding the Medi-Cal Inmate Eligibility Program (MCIEP) for county medical probation or compassionate release inmates.

This form is used for filing a discrimination complaint related to Title VI and ADA (Americans with Disabilities Act) in California.

This document is used for requesting an extension for a license and/or certification in California.

This form is used for obtaining fire clearance for outpatient facilities in California.

This form is used for requesting information about Medi-Cal, the California state Medicaid program, written in Chinese language.

This form is used for requesting information related to Medi-Cal benefits in California. It is available in the Cambodian language.

This Form is used for requesting information related to Medi-Cal in the Hmong language in the state of California.

This form is used for requesting information related to Medi-Cal, California's Medicaid program. It is available in Farsi language.

This form is used for requesting information related to Medi-Cal, a healthcare program in California. This specific version of the form is in Japanese.