CA DHCS 4000 A 2010-2025 free printable template

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

How to fill out genetically handicapped persons program form

How to fill out CA DHCS 4000 A

1. Begin by obtaining the CA DHCS 4000 A form from the official DHCS website.
2. Fill in the personal information section at the top, including your name, address, and contact details.
3. Complete the section regarding your insurance information, if applicable.
4. Provide any required medical information, such as your diagnosis and relevant history.
5. Carefully read the instructions provided on the form to ensure all sections are completed accurately.
6. Review the information for any errors or omissions.
7. Sign and date the form at the designated areas.
8. Submit the completed form to the appropriate department as instructed.

Who needs CA DHCS 4000 A?

1. Individuals applying for Medi-Cal services in California.
2. Patients needing to report changes in their medical or insurance status.
3. Healthcare providers submitting necessary documentation for patient eligibility.

Video instructions and help with filling out and completing ghpp eligibility form

Instructions and Help about ghpp application

Whoosh click beep — So before wget starteded I'm gonna tell you just a little about me just to kinda let you know the perspective and the mindset that I have and where I come from why I have that mindset And I'll start with kind of a personal note My wife is here with me Frisian and audience applauds We've been married for over 30 years, but we have three children and our youngest is special needs He is diagnosed with both intellectual and some physical disabilities, and he's 22 years old And from a parental perspective you know I've been in law enforcement this is my 30th year in law enforcement and from a parental perspective I know probably many of you who either have somebody in your family you have one of your loved ones that you're close to or many of you who have special needs in the audience me being in this line of work one of the things that I think about often is what would happen if my son is our son came in contact with law enforcement and how would he react if we're not around or his brothers and sisters some other person is not around to guide him through that encounter And I do and my wife as well think about that quite often On the other side from professional perspective it always crosses my mind about what can we do to get better What can I do Now particularly now that I'm in this position what can I personally do to make the situation better for others And I think there's a lot of work to be done in this regard, and I'm really happy and pleased that the San Francisco Police Department is taking steps in that direction to really make our interactions and our encounters with people and persons with intellectual disabilities and physical disabilities to make those encounters better So that's going to be the focus of my presentation today and it's a PowerPoint but will kind of interject There are some videos that are here and some of them are pretty, pretty intense to say the least but the reason I want to show those videos to you is because the issues that we're discussing are issues that really can amount to life and death situations if we law enforcement police officers don't handle them properly So as I said there is personal component to this for me, I'm personally vested in this and the bottom line on the vision that you'll hear about shortly is you know we want to get better we want to be we the SanFrancisco Police Department I think law enforcement in general we want to do this right in terms of being able to deliver services to everybody that we come in contact disabled or not So that will be the focus of this presentation So disclosure there's nothing for me to disclose really I'm not being paid for this presentation There are no fees attached to this I'm doing it strictly because I want us to make a difference So here's our overview In the past few years spotlight has been basically on negative police encounters particularly with persons in mental crisis and debilitating oftentimes long-term illnesses and that includes...

People Also Ask about ghpp eligibility

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.

For pdfFiller’s FAQs

Where do I find ghpp form?

The pdfFiller premium subscription gives you access to a large library of fillable forms (over 25 million fillable templates) that you can download, fill out, print, and sign. In the library, you'll have no problem discovering state-specific ghpp application form and other forms. Find the template you want and tweak it with powerful editing tools.

How do I execute ghpp application pdf online?

Easy online ghpp completion using pdfFiller. Also, it allows you to legally eSign your form and change original PDF material. Create a free account and manage documents online.

How do I fill out the ghpp programs form on my smartphone?

On your mobile device, use the pdfFiller mobile app to complete and sign ghpp number. Visit our website (https://edit-pdf-ios-android.pdffiller.com/) to discover more about our mobile applications, the features you'll have access to, and how to get started.

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.