WebThe Child Health and Disability Prevention Program (CHDP) Program is a "Gateway" to provide access for over one million uninsured children to the Medi-Cal or the Covered California Program through an automated pre-enrollment process. Step 1: After speaking with you, parent or guardian, to determine if your child does not have insurance that ... WebStep 2: Log onto chdpgateway.com and enter new user ID and password from notification. Your contact information will be automatically pre-populated onto each new PM-160 Information Only form. Step 3: Enter the member’s demographic and CHDP assessment data. Complete all required fields. If these are not completed, the e-portal will not allow ...
Gateway — How can I get Medi-Cal Services TODAY!
WebCHDP Referral - PM 357. Confidential Referral/Follow-Up Report - PM 161. Confidential Screening/Billing Report - PM 160 (Refer to EDS Print and Distribution Section, Page 10 … Department of Health Care Services. Child Health and Disability Prevention … WebI am requesting a CHDP health examination today. I certify that I have read and understand this form. I declare that the information I have provided is true, correct, and complete. Signature of parent/guardian or emancipated minor Relationship to patient Date An individual has a right to review records containing his/her personal information. black and white tea cup images
CHDP Check-up - ACPHD
WebCHDP Program 9616 Micron Ave Suite 670 Sacramento, CA 95827 Map Business Hours: 8:00 AM - 5:00 PM Monday through Friday Telephone: (916) 875-7151 Webfrom the CHDP Downloads page after logging onto the Transaction Services area of the Medi-Cal website (www.medi-cal.ca.gov). Versions of the DHCS 4073 form in other … WebSteps to Getting a FREE CHDP Exam. Step 1: Go to any CHDP provider office to apply. You can view the list of offices or call us at 510-618-2070. Step 2: Fill out 1-page CHDP form. If eligible, the child or youth will receive temporary Medi-Cal health insurance through CHDP Gateway. This insurance will pay for doctor visits and other services. black and white tea length wedding dress