California Correctional Health Care Services

Official Website: https://cchcs.ca.gov

California Correctional Health Care Services (CCHCS) provides care that includes medical, dental, and mental health services, to California’s prison inmate population at all 35 California Department of Corrections and Rehabilitation (CDCR) institutions statewide.

The mission is to facilitate the successful reintegration of the individuals in our care back to their communities equipped with the tools to be drug-free, healthy, and employable members of society by providing education, treatment, rehabilitative, and restorative justice programs, all in a safe and humane environment.

Forms & Documents

Browse all California Correctional Health Care Services government forms

41 - 60 of 160 forms

Form Title Topics
DHCS 1734 (06/13): Application for Certification of Social Rehabilitation Program Service
DHCS 1735 Medi-Cal (M/C) Certification Transmittal (09/2014)
DHCS 1736 County-Owned and Operated Certification Application (09/2014)
DHCS 1737 County-Owned and Operated Provider Self-Survey Form (09/2014)
DHCS 1738 (08/14): County Mental Health Plan (MHP) Attestation
DHCS 1739 (06/13): Mental Health Professional Licensing Waiver Request
DHCS 1746 Director's Designee Information
DHCS 1800 (MH 300): Electroconvulsive Treatment (ECT), Informed Consent Form
DHCS 1800 SP: Electroconvulsive Treatment (ECT), Informed Consent Form (Spanish)
DHCS 1801 (MH 302): Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
DHCS 1802 (MH 303): Involuntary Patient Advisement
= DHCS 1803 (MH 306): Patient Rights Denial - Monthly Talley
DHCS 1804 (MH 307): Denial of Rights/Seclusion & Restraint - Monthly
DHCS 1805 (MH 308): Denial of Rights/Seclusion & Restraint - Quarterly
DHCS 1806 (MH 309): Convulsive Treatments Administered - Quarterly Report (use DHCS 1011)
DHCS 1807 (MH 560): Authorization for Release of Protected Health Information and Confidential Information
DHCS 1807 SP: Authorization for Release of Protected Health Information and Confidential Information (Spanish)
DHCS 1808 (MH 1760): Notice of Certification
DHCS 1809 (MH 1761): Notice of Certification for Additional 14 Days Intensive Treatment
DHCS 1810: Inventory of County 5150 Designated Facilities

Contact Information & Office Locations

1 contact point

Inmate Dental Services Program

Address:
PO Box 588500
Elk Grove, CA 95758

Phone numbers:
  • (916) 691-3174

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