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Forms and Publications for Clients

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Children with Special Health Care Needs (CSHCN) Services Program logo

Program Application

Please print the form, fill it out, and mail it to your local office.

CSHCN Services Program Application (708 KB, PDF) Publication #T-3

CSHCN Services Program Application in Spanish (744 KB, PDF)

Handbook

The CSHCN Services Program Client Handbook, Publication #E07-12357 (575 KB, PDF), provides basic information for program clients. 

Address Change Form

Address Change Form (483 KB PDF) / Formulario de cambio de domicilio Publication #EF07-12595, bilingual English and Spanish

Drug Co-Pay Reimbursement

Client Drug Co-Pay Reimbursement Request Form 2009 (47 KB Word) Publication #EF-07-13429, bilingual English and Spanish

Client Drug Co-Pay Reimbursement Request Form 2009 (96 KB PDF) Publication #EF-07-13429, bilingual English and Spanish

Physician/Dentist Assessment Form

CSHCN Services Physician/Dentist Assessment Form (118 KB PDF)

CSHCN Services Physician/Dentist Assessment Form Instructions (23 KB PDF)

School Attendance Verification Form

School Attendance Verification Form (482 KB PDF) Publication #EF-07-12840, bilingual English and Spanish


Emergency Forms and Information

Medication Form Publication #EF07-12780, bilingual English and Spanish (PDF)

Emergency Information Form Publication #EF07-12540, bilingual English and Spanish (PDF)

Emergency and Disaster Planning Guide Publication #4-2, bilingual English and Spanish (PDF)  

Newsletter

The CSHCN Services Program Newsletter for Families is published quarterly.

Program Brochure

Download the brochure in English Stock No. 4-1 (474 KB, PDF). The file contains a copy of the brochure in color and black and white. Use the bookmarks to access either the color or black and white version.  

Summer Camps

Summer Camps is a list of camps for children and others with special needs. 


Send comments or report broken links by e-mail to CSHCN Services Program

Last updated April 14, 2014