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State of California Health and Human Services AgencyDepartment of Health Care ServicesAPPLICATION FOR UP TO 72HOUR ASSESSMENT, EVALUATION, AND CRISIS INTERVENTION OR PLACEMENT FOR EVALUATION AND TREATMENT

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How to fill out form dhcs1801 application for

01

Download form dhcs1801 application from the official website of DHCS.

02

Fill out personal information section including name, address, and contact information.

03

Provide information about household members and income details.

04

Answer specific questions related to eligibility criteria for the program.

05

Attach all necessary supporting documents such as proof of income, residency, and identification.

06

Review the completed form for accuracy and sign the application before submitting.

Who needs form dhcs1801 application for?

01

Individuals who are applying for health care coverage through DHCS programs.

02

Applicants who meet the eligibility criteria and requirements for the program.

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What is form dhcs1801 application for?

Form DHCS1801 application is used to apply for the Medi-Cal program in the state of California.

Who is required to file form dhcs1801 application for?

Individuals who meet the eligibility requirements for the Medi-Cal program are required to file form DHCS1801 application.

How to fill out form dhcs1801 application for?

You can fill out form DHCS1801 application by providing accurate information about your personal details, income, household members, and any other required information.

What is the purpose of form dhcs1801 application for?

The purpose of form DHCS1801 application is to determine eligibility for the Medi-Cal program and provide access to healthcare services for eligible individuals.

What information must be reported on form dhcs1801 application for?

Information such as personal details, income, household members, assets, and any additional information requested on the form must be reported on form DHCS1801 application.

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