Dhcs form 5999-2025

Show details

4 out of 5

40 votes

The document is a request form for the extension of a license or certification for providers of alcohol and other drug services in California. It outlines the necessary information and requirements that must be completed and submitted to the Department of Health Care Services (DHCS) to avoid termination of the license or certification. The form includes sections for provider details, type of organization, services provided, and required certifications. Compliance with regulations and submission deadlines is emphasized.

Here's how it works

01. Edit your dhcs 5140 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send dhcs 5999 via email, link, or fax. You can also download it, export it or print it out.

How to edit Dhcs form 5999 in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on documents with our extensive and user-friendly PDF editor is easy. Adhere to the instructions below to complete Dhcs form 5999 online easily and quickly:

Log in to your account. Sign up with your credentials or register a free account to test the product prior to upgrading the subscription.
Upload a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Dhcs form 5999. Easily add and highlight text, insert pictures, checkmarks, and icons, drop new fillable areas, and rearrange or remove pages from your paperwork.
Get the Dhcs form 5999 accomplished. Download your modified document, export it to the cloud, print it from the editor, or share it with other people using a Shareable link or as an email attachment.

Benefit from DocHub, one of the most easy-to-use editors to rapidly handle your paperwork online!

See more dhcs form 5999 versions

We've got more versions of the dhcs form 5999 form. Select the right dhcs form 5999 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (42 Votes)
2014	4 Satisfied (40 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is DHCS the same as Medi-Cal?

DHCS is the single state agency responsible for financing and administering the states Medicaid program, Medi-Cal, which provides health care services to low-income persons and families who meet defined eligibility requirements. Medi-Cal is authorized and funded through a federal-state partnership.

Is California DHCS Medicaid?

What is Medicaid in California called?

0:22 1:59 First up we have the traditional Medicaid. This ones the original program it covers hospital visitsMoreFirst up we have the traditional Medicaid. This ones the original program it covers hospital visits doctor appointments. And even long-term Medical Care.

What are the four types of Medicaid?

The California Department of Health Care Services (DHCS) is a department within the California Health and Human Services Agency that finances and administers a number of individual health care service delivery programs, including Medi-Cal, which provides health care services to low-income people.

What is DHCS certification?

The appeal process is available to any participant, his/her representative or treating provider who disputes denial of payment for a service or the denial, deferral or modification of a service by the primary care physician (PCP) or any member of the interdisciplinary team (IDT) who is qualified to make referrals.

How much is the application fee for the DHCS?

Application Fee for Calendar Year 2025 This fee amount is established by the Centers for Medicare Medicaid Services (CMS) for each calendar year and the new $730.00 amount is required with any applicable enrollment application submitted on or after January 1, 2025 and on or before December 31, 2025.

Dhcs form 5999-2025

Here's how it works