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State of California Health and Human Services AgencyDepartment of Health Care Services Licensing and Certification Division MS 2600 PO Box 997413 Sacramento, CA 958997413PROGRAM INVESTIGATIVE REPORT
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Get a copy of the dhcs 4026 form from the Department of Health Care Services.
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Provide information about the patient or client for whom the form is being filled, including their name, date of birth, and any relevant identification numbers.
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Who needs dhcs 4026?
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dhcs 4026 is needed by individuals who are seeking or receiving healthcare services from the Department of Health Care Services. This form is commonly used for assessing eligibility or enrollment in various healthcare programs, such as Medi-Cal.
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What is dhcs 4026?
DHCS 4026 is a form used by California's Department of Health Care Services (DHCS) for reporting Medi-Cal eligible individuals and services.
Who is required to file dhcs 4026?
Health care providers, organizations, and plans that serve Medi-Cal beneficiaries are required to file DHCS 4026.
How to fill out dhcs 4026?
To fill out DHCS 4026, you need to provide accurate information regarding the services rendered, patient details, and your provider information as specified in the form's instructions.
What is the purpose of dhcs 4026?
The purpose of DHCS 4026 is to collect data on the utilization of Medi-Cal services to ensure compliance with state regulations and improve healthcare delivery.
What information must be reported on dhcs 4026?
Information that must be reported on DHCS 4026 includes patient demographics, types of services provided, service dates, billing information, and provider details.
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