CA HCPCFC Foster Care Medical (Specialty) Contact Form - Sacramento County 2017-2025 free printable template

Health Care Program for Children in Foster Care (CPCFC) Foster Care Medical (Specialty) Contact Form Submit to the Sacramento County CHIP Program within 5 business days of the examination fax: (916)

How to fill out hcpcfc form

How to fill out CA HCPCFC Foster Care Medical (Specialty) Contact

1. Begin with the child's personal information: Fill in the child's full name, date of birth, and any identification numbers.
2. Provide the foster parent's details: Include the foster parent's name, address, and contact information.
3. Detail the child's medical history: List any medical conditions, medications, allergies, and previous treatments.
4. Complete the insurance information: Input the child's health insurance details including policy numbers and provider contact.
5. Include the names of medical professionals: Write down the names and contact information of the child's primary care physician and any specialists.
6. Complete the additional consent forms: If applicable, provide consent for medical treatment and information sharing.
7. Review for accuracy: Double-check all entries for completeness and accuracy before submission.
8. Submit the form: Send the completed form to the appropriate agency or medical facility as instructed.

Who needs CA HCPCFC Foster Care Medical (Specialty) Contact?

1. Foster children who require medical evaluation or treatment in California.
2. Foster care providers who need to document the health care services utilized by the child in their care.
3. Social workers involved in the coordination of health services for children in the foster system.

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What is CA HCPCFC Foster Care Medical (Specialty) Contact?

CA HCPCFC Foster Care Medical (Specialty) Contact is a form used in California to facilitate the communication and coordination of medical care for children in foster care.

Who is required to file CA HCPCFC Foster Care Medical (Specialty) Contact?

Healthcare providers, foster care agencies, and caregivers responsible for the medical care of foster children are required to file the CA HCPCFC Foster Care Medical (Specialty) Contact.

How to fill out CA HCPCFC Foster Care Medical (Specialty) Contact?

To fill out the CA HCPCFC Foster Care Medical (Specialty) Contact, you need to provide details such as the child's name, date of birth, foster care placement information, medical history, and any specific medical needs that should be addressed.

What is the purpose of CA HCPCFC Foster Care Medical (Specialty) Contact?

The purpose of the CA HCPCFC Foster Care Medical (Specialty) Contact is to ensure that foster children receive timely and appropriate medical care, while also documenting their health needs for continuity of care.

What information must be reported on CA HCPCFC Foster Care Medical (Specialty) Contact?

Information that must be reported includes the child's identifying information, medical history, current medications, allergies, treatment plans, and any healthcare provider details.