Example: dental hygienist
Search results with tag "Initial treatment provider application"
Level of Care Designation Application - DHCS 4022
www.dhcs.ca.govDesignation application must be submitted concurrently with an Initial Treatment Provider Application (DHCS 6002), including required fees and supporting documentation, to the Department. If you are applying for a LOC designation for multiple facilities, you must submit an application package for each corresponding facility.
INITIAL TREATMENT PROVIDER APPLICATION - California
www.dhcs.ca.govall fees paid. Please complete all applicable sections of the application. If a line or question does not apply to you, fill the line or question with “N/A.” If an entire section does not apply to your application, place a check mark in the “N/A” box located in the section heading.