Appendix: Supplemental Materials
- Appendix: Supplemental Materials Contents
- 15-Day Reminder Notice
- Aid Codes Master Chart
- American Dental Association's "Classification of Treatment Needs"
- Asian and Pacific Islander Groups Reported in the 1980 Census
- * California Child Health and Disability Prevention (CHDP) Program: CHDP Health Assessment Provider Application (DHCS 4490)
- * California Child Health and Disability Prevention (CHDP) Program: CHDP Laboratory Provider Application (DHS 4502)
- California Child Health and Disability Prevention (CHDP) Program: Health Assessment Provider Program Agreement (DHCS 4491)
- California Child Health and Disability Prevention (CHDP) Program: Laboratory Provider Program Agreement (DHS 4503)
- * California Child Health and Disability Prevention Program: Consent Form (PM 211) (English/Spanish version)
- CDC Growth Charts – Body Mass Index-for-Age Percentiles
- Change in Provider Information Letter
- * CHDP Confidential Referral/Follow-up Report (PM 161)
- CHDP Provider Approval Letter (Sample Letter)
- Child Health and Disability Prevention (CHDP) Program: Facility Review Tool Scoring Instructions (DHCS 4493)
- Child Health and Disability Prevention (CHDP) Program: Medical Record Review Tool Scoring Instructions and Reviewer Guidelines (DHS 4492)
- Child Health and Disability Prevention Pre-Enrollment Application (DHCS 4073, Version 9/07, Armenian)
- Child Health and Disability Prevention Pre-Enrollment Application (DHCS 4073, Version 9/07, Cambodian)
- Child Health and Disability Prevention Pre-Enrollment Application (DHCS 4073, Version 11/07, Chinese)
- Child Health and Disability Prevention Pre-Enrollment Application (DHCS 4073, Version 12/07, English)
- Child Health and Disability Prevention Pre-Enrollment Application (DHS 4073, Version 6/04, Farsi)
- Child Health and Disability Prevention Pre-Enrollment Application (DHS 4073, Version 6/04, Hmong)
- Child Health and Disability Prevention Pre-Enrollment Application (DHS 4073, Version 6/04, Korean)
- Child Health and Disability Prevention Pre-Enrollment Application (DHCS 4073, Version 9/07, Lao)
- Child Health and Disability Prevention Pre-Enrollment Application (DHS 4073, Version 6/04, Russian)
- Child Health and Disability Prevention Pre-Enrollment Application (DHS 4073, Version 6/04, Spanish)
- Child Health and Disability Prevention Pre-Enrollment Application (DHS 4073, Version 6/04, Vietnamese)
- Confidential Morbidity Report (PM 110) (front)
- Confidential Morbidity Report (PM 110) (back)
- Confidential Screening/Billing Report (PM 160)
- Confidential Screening/Billing Report (PM 160 Information Only)
- Cover Letter
- Extension of Eligibility Letter
- Important Information About the CHDP Gateway to Health Coverage (Pre-Visit Flyer)
- Local CHDP Directory
- Periodicity Schedule for Dental Referral by Age
- Periodicity Schedule for Health Assessment Requirements by Age Groups
- Recommended Childhood and Adolescent Immunization Schedules
- ** For Children and Adolescents Who Start Late or Who Are > 1 Month Behind
- Report of Health Examination for School Entry (PM 171 A) (English/Spanish version)
- Waiver of Health Examination for School Entry (PM 171 B) (English/Spanish version)
- Your Child Now Has Free Temporary Medi-Cal Health Coverage (Post-Visit Flyer)
** This information appears on page 2 of the Recommended Childhood and Adolescent Immunizations Schedule -- United States, 2003.de
Note:
If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.