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State of CaliforniaHealth and Human Services AgencyDepartment of Health Care Services RICHARD FIGUEROA ACTING DIRECTORGAVIN NEWSOM GOVERNOR January 29, 2020CHDP Provider Information Notice No.: 2001TO:All

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How to fill out chdp pin 20-01

01

To fill out CHDP PIN 20-01, follow these steps:

02

Start by entering the date at the top of the form in the designated field.

03

Provide the name of the child for whom the form is being filled out.

04

Fill in the child's date of birth and gender.

05

Enter the complete address of the child, including street name, city, state, and ZIP code.

06

Provide the name of the child's parent or guardian.

07

Enter the parent/guardian's contact number and email address.

08

Fill in the details of the child's health insurance, including the insurance company's name, policy number, and contact information.

09

Indicate the name and contact information of the doctor or clinic where the child receives medical care.

10

Specify if the child has any special health care needs or medical conditions.

11

Finally, sign and date the form to complete the process.

Who needs chdp pin 20-01?

01

CHDP PIN 20-01 is needed by individuals who want to apply for the California Child Health and Disability Prevention (CHDP) program.

02

This program provides comprehensive preventive health assessments and services for children and youth from low-income families in California.

03

Parents or guardians of eligible children can fill out CHDP PIN 20-01 to apply for these services and receive necessary healthcare support for their children.

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What is chdp pin 20-01?

CHDP pin 20-01 is a unique identification number assigned to each Child Health and Disability Prevention (CHDP) program participant.

Who is required to file chdp pin 20-01?

Healthcare providers participating in the CHDP program are required to file CHDP pin 20-01 for each eligible patient.

How to fill out chdp pin 20-01?

CHDP pin 20-01 can be filled out by entering the necessary patient information, including name, date of birth, and medical history.

What is the purpose of chdp pin 20-01?

The purpose of CHDP pin 20-01 is to track and monitor the health status of children and ensure they receive necessary preventative care.

What information must be reported on chdp pin 20-01?

Information such as immunization records, developmental screenings, and physical exam results must be reported on CHDP pin 20-01.

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