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State of California Health and Human Services AgencyDepartment of Health Care ServicesAssisted Living Waiver Change of CCA Form Richard Figueroa Acting Director Gavin Newsom Governor, hereby request

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How to fill out dhcs 0061 assisted living

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To fill out the DHCS 0061 Assisted Living form, follow these steps:

02

Start by providing your personal information, including your name, date of birth, and contact information.

03

Indicate your current living situation and whether you have received any previous assisted living services.

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Specify your medical conditions, disabilities, and any medications you are currently taking.

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Provide information about your income, including any sources of financial assistance.

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Detail your housing situation and any special needs or accommodations you require.

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Include information about any supportive services or caregivers you currently have.

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Sign and date the form, certifying that the information provided is true and accurate.

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Submit the completed form to the appropriate DHCS office or designated agency.

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What is dhcs 0061 assisted living?

DHCS 0061 assisted living is a form used to report assisted living facility information to the California Department of Health Care Services (DHCS).

Who is required to file dhcs 0061 assisted living?

Assisted living facilities in California are required to file DHCS 0061 assisted living.

How to fill out dhcs 0061 assisted living?

DHCS 0061 assisted living can be filled out manually or electronically, following the instructions provided on the form.

What is the purpose of dhcs 0061 assisted living?

The purpose of DHCS 0061 assisted living is to collect data on assisted living facilities in California to ensure compliance with regulations and quality of care standards.

What information must be reported on dhcs 0061 assisted living?

Information such as facility name, address, services provided, capacity, and staffing levels must be reported on DHCS 0061 assisted living.

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