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

101 - 120 of 160 forms

Form Title Topics
GHPP New Referral
GHPP New Referral
Health Assessment Provider Agreement
Health Assessment Provider Application
Health Insurance Information
Hearing Screening Request Waiver
HIPP Application Form - Fillable
HIPP Disclosure Statement
Intermediate Care Facility for the Developmentally Disabled Habilitative/Nursing (ICF-DDH/N) Cost Report
Intermediate Care Facility for the Developmentally Disabled Habilitative/Nursing (ICF-DDH/N) Home Office Cost Report
Laboratory Provider Application
Laboratory Provider Program Agreement
Maintenance and/or Transportation Authorization
Master Index Rejection Notice
MC 1982 A: SD/MC Quarterly Claim for Reimbursement - Treatment Cost
MC 1982 B: SD/MC Quarterly Claim for Reimbursement - Administrative Cost.xls
MC 1982 C: SD/MC Monthly Claim for Reimbursement - Quality Assurance/Utilization Review (QA/UR) Cost
MC 1982 D: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA)
MC 1982 G: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA)
MC 5120AD - Vendor Approver Certification

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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