Get the free DHCS 90 Day Notification to HFP Members (Phase 2) - lacare

P.O. Box 989009, West Sacramento, CA 95798-9850 January 1, 2013, Important Information About the Healthy Families Program Move to Medical Dear Healthy Families parent or guardian: Starting no sooner

How to fill out dhcs 90 day notification

How to fill out dhcs 90 day notification:

1. Obtain the dhcs 90 day notification form from the official website or local health department.
2. Fill in the required personal information, such as your name, address, and contact details.
3. Provide information about the medical condition or disability that requires the 90 day notification.
4. Clearly state the anticipated dates and duration of the medical treatment or absence from the program.
5. Include any supporting documentation or medical certificates that validate the need for the notification.
6. Sign and date the form, ensuring that all information is filled out accurately and legibly.
7. Submit the completed form to the designated department or personnel responsible for processing the dhcs 90 day notification.

Who needs dhcs 90 day notification:

1. Individuals who are enrolled in a health care program under the California Department of Health Care Services (DHCS).
2. Patients who have a medical condition or disability that requires them to temporarily leave the program for medical treatment or absence reasons.
3. Caregivers or advocates who are assisting individuals in their dhcs enrollment and notification processes.

For pdfFiller’s FAQs

What is dhcs 90 day notification?

DHCS 90 day notification is a notification required by the California Department of Health Care Services (DHCS) to inform them of any changes or updates in the provider's information or status within 90 days of the change.

Who is required to file dhcs 90 day notification?

Any provider enrolled in a Medi-Cal program is required to file DHCS 90 day notification.

How to fill out dhcs 90 day notification?

DHCS 90 day notification can be filled out online through the Medi-Cal website or by submitting a paper form to DHCS.

What is the purpose of dhcs 90 day notification?

The purpose of DHCS 90 day notification is to ensure that DHCS has updated and accurate information about providers participating in the Medi-Cal program.

What information must be reported on dhcs 90 day notification?

Providers must report any changes in their practice location, contact information, ownership status, services offered, or any other relevant information.

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