Form DHCS4073 Pre-enrollment Application - Child Health and Disability Prevention (Chdp) Program - California (Hmong)

Form DHCS4073 Pre-enrollment Application - Child Health and Disability Prevention (Chdp) Program - California (Hmong)

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.

The document is provided in Hmong. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHCS4073 Form?
A: The DHCS4073 Form is a pre-enrollment application for the Child Health and Disability Prevention (CHDP) Program in California.

Q: What is the CHDP Program?
A: The CHDP Program is the Child Health and Disability Prevention Program, which provides free preventive health evaluations and services for low-income children and youth in California.

Q: Who is eligible for the CHDP Program?
A: Low-income children and youth in California are eligible for the CHDP Program.

Q: What is the purpose of the DHCS4073 Form?
A: The DHCS4073 Form is used to apply for enrollment in the CHDP Program and provide necessary information about the child's health and disability history.

Q: Is the DHCS4073 Form available in Hmong language?
A: Yes, the DHCS4073 Form is available in Hmong language to accommodate Hmong-speaking individuals in California.

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Form Details:

  • Released on October 1, 2013;
  • The latest edition provided by the California Department of Health Care Services;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form DHCS4073 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.

Download Form DHCS4073 Pre-enrollment Application - Child Health and Disability Prevention (Chdp) Program - California (Hmong)

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  • Form DHCS4073 Pre-enrollment Application - Child Health and Disability Prevention (Chdp) Program - California (Hmong), Page 1
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