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Este formulario permite que un padre, tutor o representante legal solicite al Departamento de Servicios de Salud de California que informe sobre las divulgaciones de información de salud protegida
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How to fill out DHCS 6245a

01
Begin by gathering all necessary personal and health information.
02
Start filling out the application by entering your name, address, and contact information in the designated fields.
03
Provide your Social Security number, if applicable, and date of birth.
04
Indicate your health insurance status by checking the appropriate boxes.
05
Fill in relevant details regarding your medical history and the services you are requesting.
06
Review the form for completeness and accuracy.
07
Sign and date the application at the bottom of the form.
08
Submit the completed form to the appropriate DHCS address or online portal.

Who needs DHCS 6245a?

01
Individuals seeking to apply for Medi-Cal services.
02
Patients needing assistance with healthcare services covered by DHCS.
03
People who are eligible for state-funded health programs.
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People Also Ask about

The mission of the California Department of Health Care Services (DHCS) is to provide Californians with access to affordable, integrated, high-quality health care, including
DHCS is the single state agency responsible for financing and administering the state's Medicaid program, Medi-Cal, which provides health care services to low-income persons and families who meet defined eligibility requirements.
It was formerly known as the California Department of Health Services, which was reorganized in 2007 into the DHCS and the California Department of Public Health.
Processing your application can take several weeks because Medi-Cal must first determine eligibility by verifying your income and personal assets before coverage can be approved. You may request Medi-Cal to pay retroactively for the three months prior to the month in which you apply.
Medi-Cal is California's version of the Federal Medicaid program. The Department of Health Care Services (DHCS) oversees the Medi-Cal program. Your local county office manages most Medi-Cal cases for DHCS.

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DHCS 6245a is a form used by healthcare providers in California to report specific information related to healthcare services and reimbursements to the Department of Health Care Services (DHCS).
Healthcare providers who participate in the California Medical Assistance Program (Medi-Cal) are required to file DHCS 6245a for reimbursement purposes.
To fill out DHCS 6245a, providers must provide accurate patient information, service details, treatment dates, and any other required data as specified in the form instructions.
The purpose of DHCS 6245a is to facilitate the proper reporting and reimbursement of healthcare services provided to Medi-Cal beneficiaries.
Information that must be reported on DHCS 6245a includes patient identification details, service codes, dates of service, provider information, and any relevant billing or claim details.
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