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  • Health Access Programs Family Pact Program Client Eligibility Certification Form

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Print Form Clear Form State of California Health and Human Services Agency California Department of Public Health HEALTH ACCESS PROGRAMS FAMILY PACT PROGRAM CLIENT ELIGIBILITY CERTIFICATION CEC Client identification number This form is the property of the State of California California Department of Public Health Office of Family Planning and cannot be change d or altered. Please print answers to all questions.

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ing to the World Health Organization (WHO), family planning is defined as “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births.

Family PACT covers the following services: Various birth control methods, including long-acting reversible contraceptives, emergency contraception, and sterilization. Family planning counseling and education. Sexually transmitted infection (STI) testing & treatment.

“Site Certifier” – each service site location must designate one eligible representative to be a site certifier. The site certifier is responsible for overseeing family planning services at the location to be enrolled. A Medical Director, MD, CNP, or CNM is eligible to certify a site.

Medi-Cal administers the Family PACT program. Family PACT providers are encouraged to check the Medi-Cal website frequently and sign up for the Medi-Cal Subscription Service to receive updates via email.

The Family Planning, Access, Care, and Treatment (Family PACT) program provides low-income women, men and teens with access to health information, counseling, and family planning services to reduce the likelihood of unintended pregnancy and maintain reproductive health.

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.

This Client Eligibility Certification (CEC) form is the property of the State of California, Department of Health Care Services, Office of Family Planning. This form cannot be changed, altered, or prepopulated.

The HAP concept allows California residents to participate in State-funded special health care programs with one identification card. Providers are furnished with plastic, pre-numbered, teal-colored cards to distribute to clients at the time of their first service so there is no delay in care.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232