Privacy Statement (Civil Code Section 1798 et seq.) The information requested on this form is required by the Department of Health Care Services for
Privacy Statement (Civil Code Section 1798 et seq.) The information requested on this form is required by the Department of Health Care Services for
CCS is a statewide program that treats children with certain physical complete the application form on page 3 and return it to their county CCS office;.
Mar 20 2021 SUBJECT: Use of Durable Medical Equipment Request Forms 6181
CCS Recertification Application – DHS 36. Page 2 of 5. F-00475 (08/2015) Complete a current form of CCS employees and contract Providers.
Privacy Statement (Civil Code Section 1798 et seq.) The information requested on this form is required by the Department of Health Care Services for
Department of Health Care Services manages the CCS program. complete the application form on page 3 and return it to their county CCS office;.
https://www.dshs.wa.gov/sites/default/files/forms/pdf/15-456.pdf
The CCS/GHPP Discharge Planning Service Authorization Request (SAR) (form DHCS. 4489) is used when requesting specific services for a CCS client who is
This form accompanies DQA form F-00482 CCS for Persons with Mental Disorders and Substance Use Disorders Initial. Certification Application – DHS 36