California Correctional Health Care Services

State of California

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

121 - 140 of 160 forms

Form Title Topics
MC 5121AD - County-Direct Provider Approver Certification
MC 5123AD - DHCS Employee Approver Certification
MC 5131AD - County-Direct Provider User Cancellation
MC 5400 (05/2013): Application for Certification of Special Treatment Program (STP) Services
Medi-Cal Code 18 Rate Request for Managed Care Differential
Medi-Cal Code 20 Rate Request for Capitated Medicare Advantage Plans
?Medi-Cal Electronic Submission Protocol for FQHC/RHC/IHS/MOA
Medi-Cal Eligibility Data System (MEDS) Account Request
Medi-Cal Freestanding – PPS Rate Setting Cost Report
Medi-Cal Home Office Cost Report *Note same form as Adult Day Health Care Home Office Cost Report
Medi-Cal Home Office Cost Report - PPS Rate Setting
Medi-Cal Home Office Cost Report - PPS Rate Setting
Medical Statement of Diagnosis
Medi-Cal Supplemental Worksheets
Medical Therapy Unit Summary
Narrative Sheet
New Referral CCS/GHPP Client Service Authorization Request (SAR)
Notice to Terminating Employees
Patient History Transaction
Patient Therapy Record

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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