Get Department Of Health Services California Children's Services (ccs) - Sfdph

The California Children's Services (CCS) program provides essential medical services for children with specific health conditions. This guide outlines the steps to effectively complete the CCS application form online, ensuring that users have a clear and supportive resource to navigate the process successfully.

Follow the steps to fill out the CCS application form accurately

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editing tool.
2. Fill out Section A: Applicant Information. Provide the applicant’s full name, date of birth, place of birth, current residence, gender, race/ethnicity, and social security number (optional). Include details about the suspected CCS condition and the applicant’s physician.
3. Complete Section B: Parent/Legal Guardian Information. If relevant, fill in the names and addresses of the parent(s) or legal guardian, including day, evening, and message phone numbers.
4. Proceed to Section C: Health Insurance Information. Indicate whether the applicant has Medi-Cal, is enrolled in the Healthy Families program, and provide information regarding any other health, dental, and vision insurance.
5. Finally, fill out Section D: Certification. Sign and date the form, ensuring that the relationship to the applicant is documented. If signing with a mark, a witness signature is required.
6. Once all sections are completed and reviewed for accuracy, save your changes, and prepare to submit the application. Ensure all necessary documents are included before mailing it to your county CCS office.

Begin completing your application form online today to ensure your child receives the services they need.