Get the free DHCS Form 1738 County Mental Health Plan (MHP ...

State of California Health and Human Services Agency Department of Health Care Services COUNTY MENTAL HEALTH PLAN (MHP) ATTESTATION FISCAL YEAR (FY) 2021/2022 The MHP must complete this attestation

How to fill out dhcs form 1738 county

How to fill out dhcs form 1738 county

1. To fill out DHCS form 1738 County, follow these steps:
2. Start by obtaining the form from the DHCS (Department of Health Care Services) website or from a local DHCS office.
3. Read the instructions carefully to understand the purpose of the form and the information required.
4. Gather all the necessary information, such as personal details, income information, and any supporting documents that may be required.
5. Begin filling out the form by providing your personal information, including your name, address, contact details, and social security number.
6. Fill in the required information about your household members, including their names, relationships, and income information.
7. Provide details about your monthly expenses, including rent/mortgage, utilities, transportation costs, and any other applicable expenses.
8. Attach any supporting documents that are requested, such as proof of income, residency, or insurance coverage.
9. Review the completed form to ensure all the information is accurate and complete.
10. Sign and date the form in the designated spaces.
11. Make a copy of the filled-out form for your records and submit the original form to the appropriate DHCS office by mail or in person.
12. Keep a record of when and how you submitted the form, in case any follow-up or verification is needed.
13. If you have any questions or need assistance, contact the DHCS office for guidance.

Who needs dhcs form 1738 county?

1. DHCS form 1738 County is typically needed by individuals or households who are seeking county-specific health care services or assistance.
2. It may be required for various purposes, such as applying for Medi-Cal benefits, enrollment in county health programs, or seeking financial assistance for medical expenses.
3. Specific eligibility criteria may apply, and the form helps determine if an individual or household qualifies for the services or assistance provided by the county.
4. It is recommended to check with the DHCS office or county health department to determine if DHCS form 1738 County is needed for a specific situation.

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What is dhcs form 1738 county?

DHCS Form 1738 County is a document used for reporting information related to healthcare services provided in a particular county.

Who is required to file dhcs form 1738 county?

Healthcare providers and facilities that offer services in a specific county are required to file DHCS Form 1738 County.

How to fill out dhcs form 1738 county?

DHCS Form 1738 County can be filled out by providing detailed information about the healthcare services offered, including patient demographics and service codes.

What is the purpose of dhcs form 1738 county?

The purpose of DHCS Form 1738 County is to collect data on healthcare services provided within a county for monitoring and reporting purposes.

What information must be reported on dhcs form 1738 county?

Information such as the type of services provided, number of patients served, and any relevant service codes must be reported on DHCS Form 1738 County.