Provider Enrollment

• New Provider Application
• Provider Agreement

Site Review Documents

• Facility Review Tool
• Medical Record Review Tool

Care Coordination Form

• Care Coordination / Follow-up Form

Client Forms

• Consent Form
• English - Pre-Enrollment Application
• Spanish - Pre-Enrollment Application

Materials Order Form

• Provider Materials Order Form

Patient Education

• CHDP Information Brochure (English) (Spanish)
• VCPH CHDP Medical Provider Directory
• VCPH CHDP Medical and Dental Home Flyer (English/Spanish)
• Growing Up Healthy Brochures (English) (Spanish)
• Notice of Privacy Practices (English) (Spanish)
• 2020 Recommended Vaccinations for Infants and Children: Birth-6 years old
• 2020 Recommended Vaccinations for Children: 7-18 years old 

Other Documents

• Eligibility Determination Table 2016
• Bright Futures Periodicity Schedule
• Bright Futures Periodicity Schedule Breakdown
• CDR Head Start Physical Examination Form
• CDR Head Start/State Preschool Program Dental Care Report

Online Resources

• State Child Health & Disability Prevention (CHDP) Program
• American Academy of Pediatrics (AAP)
• Medi-Cal Bulletin Archives
• Medi-Cal Provider Information Notices
• Medi-Cal Provider Manual