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D. Medi-Cal Child Health and Disability Prevention (CHDP) PM160 Information. Only Form. 1) See CHDP PM160 Information Only form completion instructions .

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Health care providers wishing to enroll as a provider with the CHDP Program must complete an application and be approved by the local CHDP Program in order to bill the CHDP Program for CHDP services. Laboratories must use the CHDP Laboratory Provider Application (DHS 4502).

Child Health and Disability Prevention Program Forms.

To receive CHDP services, children and youth must live in California and meet one of the following requirements: Up to 21 years of age and on Medi-Cal. Up to 19 years of age and from a low-income family. Between the ages of 3 and 5 years and attend a Head Start or state preschool.

CHDP provides care coordination to assist families with medical appointment scheduling, transportation, and access to diagnostic and treatment services. Health assessments are provided by enrolled private physicians, local health departments, community clinics, managed care plans, and some local school districts.

​​​​​​​​​​​​​​​Child Health and Disability Prevention Program. ​The C​hild Health and Disability Prevention (CHDP) is a preventive program that delivers periodic health assessments and services to low income children and youth in California.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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