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Get the free DHCS-4486. California Children's Services Whole Child Model Intercounty Transfer Che...

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State of California Health and Human Services AgencyDepartment of Health Care Services CCS CM Intercounty Transfer Check List Acronyms used: CCS (California Children\'s Services), CM (Whole Child
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How to fill out dhcs-4486 california childrens services

01
Obtain a copy of the DHCS-4486 California Children's Services form.
02
Complete the child's personal information section, including their name, date of birth, address, and contact information.
03
Provide details about the child's medical history and current health status.
04
Fill out the section for the parent or guardian's information, including their name, relationship to the child, and contact information.
05
Have a healthcare provider review and sign the form to verify the child's medical condition and need for services.
06
Submit the completed DHCS-4486 form to the appropriate California Children's Services office for review and processing.

Who needs dhcs-4486 california childrens services?

01
Children in California who have certain medical conditions or disabilities that require specialized medical care and services.
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DHCS-4486 is a form used in California for the Children's Services program, which provides assistance for children with special health care needs.
Providers or organizations that seek reimbursement for services rendered to children within the California Children's Services program are required to file DHCS-4486.
To fill out DHCS-4486, you need to complete all required fields accurately, providing information about the child, services provided, and any necessary support documentation.
The purpose of DHCS-4486 is to document and request reimbursement for medically necessary services provided to eligible children with special health care needs in California.
The information that must be reported includes the child's identification details, service dates, type of service, provider information, and any supporting medical documentation.
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