Department of Health Care Services (DHCS)

State of California

Official Website: https://www.dhcs.ca.gov

​The mission of the Department of Health Care Services (DHCS) is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. The vision is to preserve and improve the overall health and well-being of all Californians.

Forms & Documents

Browse all Department of Health Care Services (DHCS) government forms

1 - 20 of 50 forms

Form Title Topics
Accounting of Disclosures by Parent, Guardian or Personal Representative Department Of Health Care Services, Privacy
Accounting of Disclosures Request Department Of Health Care Services, Privacy
Amend PHI by Parent, Guardian or Personal Representative Department Of Health Care Services, Privacy
Amend PHI Request Department Of Health Care Services, Privacy
Application to determine CCS Program Eligibility Department Of Health Care Services, Nhsp, NHSP
Brochure Forms Department Of Health Care Services, Nhsp, NHSP
Communication Disorder Center Application Department Of Health Care Services, Nhsp, NHSP
Confidential Communications Request Department Of Health Care Services, Privacy
DHCS 100186 Form - DMC Claim Submission Certification - County Contracted Provider Department Of Health Care Services, Drug Medi-Cal Treatment
DHCS 100187 Form - DMC Claim Submission Certification - County Operated Provider Form Department Of Health Care Services, Drug Medi-Cal Treatment
DHCS 1008 (02/13): Jail Services.pdf Department Of Health Care Services, Mental Health
DHCS 1009 (02/13): Conservatorships.pdf Department Of Health Care Services, Mental Health
DHCS 1010 (02/13): Involuntary Detentions.pdf Department Of Health Care Services, Mental Health
DHCS 1739 (06/13): Mental Health Professional Licensing Waiver Request Department Of Health Care Services, Mental Health
DHCS 1800 (MH 300): Electroconvulsive Treatment (ECT), Informed Consent Form Department Of Health Care Services, Mental Health
DHCS 1803 (MH 306): Patient Rights Denial - Monthly Talley Department Of Health Care Services, Mental Health
DHCS 1804 (MH 307): Denial of Rights/Seclusion & Restraint - Monthly Department Of Health Care Services, Mental Health
DHCS 1805 (MH 308): Denial of Rights/Seclusion & Restraint - Quarterly Department Of Health Care Services, Mental Health
DHCS 1806 (MH 309): Convulsive Treatments Administered - Quarterly Report (use DHCS 1011 Department Of Health Care Services, Mental Health
DHCS 1807 (MH 560): Authorization for Release of Protected Health Information and Confidential Information Department Of Health Care Services, Mental Health

Contact Information & Office Locations

1 contact point

Main Office

Address:
P.O. Box 997413
MS 0000
Sacramento, CA 95899-7413

Phone numbers:
  • (800) 541-5555
  • (916) 636-1980

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