California health care services 2026

1. Click ‘Get Form’ to open the California Health Care Services Initial Application Coversheet in the editor.
2. Begin with Section A, where you must select the type of application. Check all applicable boxes for Narcotic Treatment Program, Detoxification Treatment, Maintenance Treatment, Medication Unit, or Office-Based Narcotic Treatment Network.
3. Proceed to Section B and fill in your Applicant Information. Enter your License Number if applicable, National Provider Identifier (NPI), and the Name of Legal Entity. Ensure that you provide accurate details as required.
4. Complete the Facility Street Address and Mailing Address fields accurately. Verify addresses using the United States Postal Service website to avoid errors.
5. In Section D, print your name as the program sponsor, sign the form, and date it. This confirms that all information provided is true and complete.

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