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Health Net State Health Programs MediCalCHDP PM160 INF Form Instructions Lisa Papillae, Health Net Were invested in supporting provider practices. C COMPLETING THE PM 160 INF F ORM This guide contains

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How to fill out chdp pm 160 inf

01

Obtain a CHDP PM 160 INF form from your healthcare provider or local health department.

02

Fill out all the required fields on the form, including personal information such as name, date of birth, and address.

03

Provide information about the child's health history, including any medical conditions or medications they are currently taking.

04

Sign and date the form, certifying that all the information provided is accurate.

05

Submit the completed form to the appropriate healthcare provider or agency for review and processing.

Who needs chdp pm 160 inf?

01

Parents or guardians of children who are eligible for the Child Health and Disability Prevention (CHDP) program may need to fill out the CHDP PM 160 INF form.

02

Healthcare providers and agencies administering the CHDP program may also require the completion of this form for enrollment or eligibility determination.

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What is chdp pm 160 inf?

The CHDP PM 160 Inf is a form used for reporting information related to California's Child Health and Disability Prevention (CHDP) program.

Who is required to file chdp pm 160 inf?

Healthcare providers who participate in the CHDP program are required to file the CHDP PM 160 Inf form.

How to fill out chdp pm 160 inf?

The CHDP PM 160 Inf form must be completed with accurate information regarding the services provided under the CHDP program.

What is the purpose of chdp pm 160 inf?

The purpose of the CHDP PM 160 Inf form is to track and report on the services provided to children under the CHDP program.

What information must be reported on chdp pm 160 inf?

The CHDP PM 160 Inf form requires information such as patient demographics, services rendered, referral information, and provider details.

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