This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is the DHCS4488 form?
A: The DHCS4488 form is the New Referral CCS/GHPP Client ServiceAuthorization Request (SAR) form in California.
Q: What is the purpose of the DHCS4488 form?
A: The DHCS4488 form is used to request authorization for client services under the California Children's Services (CCS) or Genetically Handicapped Persons Program (GHPP).
Q: Who can use the DHCS4488 form?
A: The DHCS4488 form is used by healthcare providers to refer clients to the CCS or GHPP programs.
Q: What information is required on the DHCS4488 form?
A: The DHCS4488 form requires information about the client, the referring provider, the diagnosing provider, and the requested services.
Form Details:
Download a fillable version of Form DHCS4488 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.