Form DHCS4468 Family Pact Provider Application - California

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What Is Form DHCS4468?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHCS4468 Family Pact Provider Application?
A: The DHCS4468 Family Pact Provider Application is a form used in California to apply for participation in the Family Planning, Access, Care, and Treatment (Family PACT) program.

Q: What is the Family Planning, Access, Care, and Treatment (Family PACT) program?
A: The Family Planning, Access, Care, and Treatment (Family PACT) program is a publicly funded family planning program in California that provides comprehensive family planning services to eligible low-income individuals.

Q: Who can use the DHCS4468 Family Pact Provider Application?
A: The DHCS4468 Family Pact Provider Application is used by healthcare providers who want to participate in the Family PACT program and provide services to eligible individuals.

Q: What information is required in the DHCS4468 Family Pact Provider Application?
A: The DHCS4468 Family Pact Provider Application requires information about the healthcare provider or organization, such as contact information, qualifications, services offered, and other relevant details.

Q: Are there any fees associated with the DHCS4468 Family Pact Provider Application?
A: No, there are no fees associated with submitting the DHCS4468 Family Pact Provider Application.

Form Details:

Released on December 1, 2018;
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;
Fill out the form in our online filing application.

Download a fillable version of Form DHCS4468 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.