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DSHS Form 4073 Pre-enrollment Application - Child Health and Disability Prevention (Chdp) Program - California (Lao)
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Lao. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 4073?A: DSHS Form 4073 is a pre-enrollment application for the Child Health and Disability Prevention (CHDP) program in California.
Q: What is the CHDP program?A: The CHDP program stands for Child Health and Disability Prevention program. It provides preventive health care services to eligible children in California.
Q: What is the purpose of the pre-enrollment application?A: The pre-enrollment application (DSHS Form 4073) is used to gather information about the child's health and eligibility for the CHDP program.
Q: Who can apply for the CHDP program?A: Parents or legal guardians of eligible children can apply for the CHDP program.
Q: What information is required on the DSHS Form 4073?A: The DSHS Form 4073 requires information about the child's personal details, medical history, and household income.
Q: Is there a fee to enroll in the CHDP program?A: No, there is no fee to enroll in the CHDP program. It is a free program for eligible children in California.
Q: What services are covered by the CHDP program?A: The CHDP program covers a range of preventive health care services, including physical exams, immunizations, dental screenings, vision and hearing tests, and developmental assessments.
Form Details:
- Released on September 1, 2007;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a printable version of DSHS Form 4073 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
