
CA MH-228 2007-2025 free printable template
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Mail to Department of Mental Health Chief Information Office Bureau Systems Access Unit 695 South Vermont Avenue Los Angeles CA 90005 RENDERING PROVIDER FORM Request Type Submit Date Update New License Reporting Unit Effective Date Terminate Name Change General Information Select DMH Classcode DMH Prov name Last Name First Name Middle Initial Sex M F DHS Ethnicity Non-Governmental Agency DMH Contracted L.E. DMH/NGA Staff Code L.E. Name FFS Ind Pr...
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How to fill out CA MH-228

How to fill out CA MH-228
01
Gather all necessary personal information, including your name, address, and date of birth.
02
Provide a detailed description of the mental health treatment you have received.
03
Include information about your current mental health status and any medications you are taking.
04
Ensure you fill out all required sections accurately, using clear and concise language.
05
Review the form for any errors or omissions before submission.
06
Submit the completed CA MH-228 form to the appropriate authority or agency as instructed.
Who needs CA MH-228?
01
CA MH-228 is required by individuals seeking to obtain or renew a mental health treatment license or certificate.
02
Mental health professionals such as therapists, psychologists, and counselors use this form as part of their licensing process.
03
It may also be needed for individuals applying for certain mental health-related services or benefits.
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What is CA MH-228?
CA MH-228 is a form used by mental health professionals in California to report various information related to mental health services and treatment.
Who is required to file CA MH-228?
Mental health service providers, including licensed therapists, psychologists, and psychiatrists who deliver services reimbursed by Medi-Cal, are required to file CA MH-228.
How to fill out CA MH-228?
To fill out CA MH-228, providers must enter specific patient information, service details, and ensure all required fields are completed accurately before submission.
What is the purpose of CA MH-228?
The purpose of CA MH-228 is to collect data for monitoring mental health services, evaluating treatment outcomes, and ensuring compliance with state and federal regulations.
What information must be reported on CA MH-228?
CA MH-228 requires reporting patient demographics, service type, duration of treatment, diagnosis, and any relevant clinical outcomes.
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