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

61 - 80 of 160 forms

Form Title Topics
DHCS 1811 (MH 5671): Authorization for Release of Patient Information
DHCS 1812 (MH 5756): Voluntary Admission Application for Mentally Disabled Person
DHCS 1813 (11/2013) / MH8001/95: Application for Licensure Mental Health Rehabilitation Center (MHRC)
DHCS 1814 (11/2013): Application for Licensure Psychiatric Health Facility (PHF) and Program
DHCS 1815 (11/2013): Application for a Special Permit of Structured Outpatient Services (SOPS)
DHCS 1816 Affidavit Regarding Client Money (MHRC)
DHCS 1817 Affidavit Regarding Patient Money (PHF)
DHCS 1818 (07/2014) Criminal Record Approval Transfer Notification
DHCS 3007 PERSONAL BACKGROUND HISTORY STATEMENT
DHCS 3085 CRIMINAL BACKGROUND CHECK: CHARACTER REFERENCE
DHCS 3131 (04/18) Application for Mental Health Program Approval Short-Term Residential Therapeutic Programs (STRTP)
DHCS 4001 Retroactive Eligibility Certification (REC)
DHCS 4001SP Retro active Eligibility Certification (REC-Spanish)
DHCS 4461 Client Eligibility Certification (CEC)
DHCS 4461SP Client Eligibility Certification (CEC-Spanish)
DHCS 4468 Application to Participate in the Family PACT Program
DHCS 5259 (06/16): CSI County Approver Certification & Vendor Appointment Form
DHCS 5260 Form - SUDCRS Approver Form
DHCS 5260 (Rev. 06/18): FAST County Approver Certification & Vendor Appointment Form
DHCS 5262 (Rev. 07/17): DCR County Approver Certification and Vendor Appointment Form

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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