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TEAR HERE State of California Health and Human Services Agency Department of Health Care Services APPLICATION FOR MEDICAL To complete this form, use the instructions. Print clearly. Use black or blue

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What is dhcsbic form?

The dhcsbic form is a form used by the California Department of Health Care Services (DHCS) to collect information about businesses that provide services to individuals with developmental disabilities.

Who is required to file dhcsbic form?

Any business that provides services to individuals with developmental disabilities in California is required to file the dhcsbic form.

How to fill out dhcsbic form?

The dhcsbic form can be filled out online through the DHCS website. It requires businesses to provide information about their services, organization structure, staffing, and other relevant details.

What is the purpose of dhcsbic form?

The purpose of the dhcsbic form is to collect information about businesses providing services to individuals with developmental disabilities in order to ensure compliance with regulations and to facilitate communication and coordination among service providers.

What information must be reported on dhcsbic form?

The dhcsbic form requires businesses to report information about their organizational structure, services provided, staffing, funding sources, and other details relevant to the provision of services to individuals with developmental disabilities.

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