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To apply, please print the following forms, fill them out, and mail them to your local health service office.
CSHCN Services Program Application (1857 KB, PDF) Publication #T-3
CSHCN Services Program Application in Spanish (550 KB, PDF) Publication #T-3A
CSHCN Services Program Physician/Dentist Assessment Form (PAF) (340 KB, PDF) Publication #T-4
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
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 Information Form Instructions (30 KB, Word)
Emergency and Disaster Planning Guide Publication #4-2, bilingual English and Spanish (PDF)
The CSHCN Services Program Client Handbook, Publication #E07-12357 (484 KB, PDF), provides basic information for program clients. Last revised on February 2017.
The CSHCN Services Program Newsletter for Families is published quarterly.
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.
Send comments or report broken links by e-mail to CSHCN Services Program.