CA DHCS 4000 A 2010-2025 free printable template
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State of California Health and Human Services Agency California Department of Health Care Services Genetically Handicapped Persons Program (GPP) GENETICALLY HANDICAPPED PERSONS PROGRAM (GPP) APPLICATION
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How to fill out CA DHCS 4000 A
How to fill out CA DHCS 4000 A
01
Begin by obtaining the CA DHCS 4000 A form from the official DHCS website.
02
Fill in the personal information section at the top, including your name, address, and contact details.
03
Complete the section regarding your insurance information, if applicable.
04
Provide any required medical information, such as your diagnosis and relevant history.
05
Carefully read the instructions provided on the form to ensure all sections are completed accurately.
06
Review the information for any errors or omissions.
07
Sign and date the form at the designated areas.
08
Submit the completed form to the appropriate department as instructed.
Who needs CA DHCS 4000 A?
01
Individuals applying for Medi-Cal services in California.
02
Patients needing to report changes in their medical or insurance status.
03
Healthcare providers submitting necessary documentation for patient eligibility.
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People Also Ask about
What is the enrollment fee for Ghpp?
For adjusted gross income between 200 and 299 percent of the federal poverty level, the annual enrollment fee shall be 1.5 percent of adjusted gross income.
How do I contact GHPP?
Phone: For general questions about GHPP, applications or renewals, please call the Integrated Systems of Care Division (ISCD) at (916) 552-9105 and make the following selections: First, select Option 2 for GHPP. Next, select Option 2 for Eligibility.
What does GHPP cover?
Medical Eligibility: GHPP covers genetic disease conditions, including hemophilia and other genetic bleeding disorders, as specified in the California Code of Regulations (CCR), Title 17, Section 2932. Age: Applicants must be 21 years of age or older.
What is the fax number for GHPP?
Fax: Service Authorization Requests (SARs): (916) 440-5318. Applications / Renewals: (916) 440-5762.
What is Ghpp eligible?
The Genetically Handicapped Persons Program (GHPP) is a health care program for adults with specific genetic diseases. GHPP helps beneficiaries with their health care costs. GHPP works with doctors, nurses, pharmacists, and other members of the health care team in providing many types of health services.
What is the enrollment fee for GHPP?
For adjusted gross income between 200 and 299 percent of the federal poverty level, the annual enrollment fee shall be 1.5 percent of adjusted gross income.
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What is CA DHCS 4000 A?
CA DHCS 4000 A is a form used by the California Department of Health Care Services for reporting the number of beds available and utilized in healthcare facilities.
Who is required to file CA DHCS 4000 A?
Healthcare facilities such as hospitals and skilled nursing facilities that are licensed in California are required to file CA DHCS 4000 A.
How to fill out CA DHCS 4000 A?
To fill out CA DHCS 4000 A, facilities must provide the requested information including the number of licensed beds, occupied beds, and any other relevant data as specified in the instructions provided with the form.
What is the purpose of CA DHCS 4000 A?
The purpose of CA DHCS 4000 A is to collect data regarding bed capacity and usage in healthcare facilities to help monitor and manage healthcare resources in California.
What information must be reported on CA DHCS 4000 A?
Required information includes the total number of licensed beds, the number of beds that are occupied, and any other specific metrics related to patient care and facility capacity as required on the form.
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