Home Health Agency Application - Department of Health Care ... - dhcs ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your name, address, city, state, zip code, phone number, fax number, and email. Ensure all contact information is accurate for effective communication.
3. Enter your license number and indicate whether you are enrolled as a Medi-Cal Provider by selecting 'Yes' or 'No'.
4. In the section regarding your in-service training program, provide a detailed description along with your method for documenting attendance.
5. Describe how you solicit and obtain feedback from clients. This is crucial for demonstrating client engagement and service improvement.
6. Outline your process for tracking incidents and client complaints to ensure accountability and quality of care.
7. Detail the service records you maintain for each client to showcase compliance with regulatory standards.
8. Explain your plan for delivering services during disasters or emergencies to highlight preparedness.
9. Describe the Individualized Response System you intend to use for the ALWPP.
10. Finally, sign and print your name along with your title and date at the bottom of the application before submission.

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