CA DHCS 5050 2013 free printable template

Psychologist B. MFT C. Physician D. LCSW Intern Effective and expiration dates of Licensure Certification or Registration Certification/registration Effective date Lic/Cert/Reg organization DHCS 5050 7/13 APPROVED CERTIFYING ORGANIZATIONS 1. STATE OF CALIFORNIA--HEALTH AND HUMAN SERVICES AGENCY Department of Health Care Services Licensing and Certification Branch MS 2600 PO Box 997413 Sacramento CA 95899-7413 A-5 FACILITY STAFFING DATA - Page 1 INSTRUCTIONS Use this double sided form to...

How to fill out dhcs 5050 2013 form

How to fill out CA DHCS 5050

1. Obtain the CA DHCS 5050 form from the official website or your local health department.
2. Fill out the section with your personal information such as name, address, and contact details.
3. Provide the details of the healthcare service or assistance you are requesting.
4. Include any necessary documentation or supporting materials as specified in the form instructions.
5. Review the completed form for accuracy and ensure all required fields are filled out.
6. Sign and date the form at the designated area.
7. Submit the completed form according to the instructions, either online, by mail, or in person.

Who needs CA DHCS 5050?

1. Individuals seeking medical assistance or services under California's Department of Health Care Services (DHCS) programs.
2. Those applying for Medi-Cal benefits or related healthcare programs.
3. Residents of California who require assistance with their healthcare needs or services.

People Also Ask about

What is DHCS certification?

Certification by DHCS identifies those facilities that exceed minimum levels of service quality and are in substantial compliance with State program standards, specifically the Alcohol and/or Other Drug Certification Standards.

What is the phone number for DHCS Medi-Cal?

​ ​​​​(800) 977-2273​ Medi-Cal Rx ​Members and Providers: If you have a question, need help, or need to report a problem, please call (800) 977-2273 for our Medi-Cal Rx Customer Service Center (CSC)​.

What is the California mental health services Law?

The MHSA was passed by California voters in 2004 and is funded by a one percent income tax on personal income in excess of $1 million per year. It is designed to expand and transform California's behavioral health system to better serve individuals with, and at risk of, serious mental health issues, and their families.

Who regulates mental health facilities in California?

The Mental Health Licensing (MHL) Section of DHCS is responsible for the licensing and oversight of mental health programs on a statewide basis, ranging from acute to long-term programs.

Does California have a Department of mental health?

The California Department of Mental Health, entrusted with leadership of the California mental health system, ensures through partnerships the availability and accessibility of effective, efficient, culturally competent services.

Do sober living homes need to be licensed in California?

It is important to note that while sober living environments or alcohol and drug free housing are not required to be licensed by DHCS, they may be subject to other types of permits, clearances, business taxes or local fees which may be required by the cities or counties in which they are located.

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What is CA DHCS 5050?

CA DHCS 5050 is a form used by health care providers in California to report information regarding the delivery of services to Medi-Cal beneficiaries.

Who is required to file CA DHCS 5050?

Health care providers participating in the Medi-Cal program are required to file CA DHCS 5050.

How to fill out CA DHCS 5050?

CA DHCS 5050 should be filled out by providing detailed information about the services provided, including dates of service, types of services rendered, and patient information as specified in the form's instructions.

What is the purpose of CA DHCS 5050?

The purpose of CA DHCS 5050 is to ensure accurate reporting of services provided to Medi-Cal beneficiaries for reimbursement and to maintain compliance with state regulations.

What information must be reported on CA DHCS 5050?

The information that must be reported on CA DHCS 5050 includes provider information, patient identifiers, dates of service, types of services provided, and any additional details required by the California Department of Health Care Services.