Dhcs 7098 english
WebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 F (06/13) SHA (9 – 11 Years) Page 1 of 2 Staying Healthy Assessment 9 – 11 Years Child’s Name (first & last) Date of Birth Today’s DateFemale Male Grade in School: Person Completing Form Parent Relative Friend Guardian WebDHCS 7098 H (Rev 12/13) SHA (Adult) Page 1 of 2. State of California —Health and Human Services Agency Department of Health Care Services 19 In the past year, have you …
Dhcs 7098 english
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WebSep 14, 2024 · State of California — Health and Human Services Agency Department of Health Care Services Staying Healthy Assessment 12 – 17 Years DHCS 7098 G (Rev … WebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 I (Rev 12/13) SHA (Senior) Page 2 of 2 Clinic Use Only Counseled Referred Anticipatory Guidance Follow-up Ordered Comments: Nutrition Physical activity Safety Dental Health Mental Health Alcohol, Tobacco, Drug Use Sexual Issues
WebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 H (Rev 12/13) SHA (Adult) Page 1 of 2 Staying Healthy … WebJan 1, 2024 · DHCS 7098 A - Staying Healthy Assessment 0-6 Months. DHCS 7098 B - Staying Healthy Assessment 7-12 Months. DHCS 7098 C - Staying Healthy Assessment 1-2 Years ... The main CHADIS interface can be viewed by patients in both English and Spanish with core questionnaires available in English, Spanish, Mandarin Chinese, and …
WebState of California —Health and Human Services Agency Department of Health Care Services . 21 . Do you smoke or chew tobacco? No Yes Skip . A l c o h o l, T ob a c c o , …
WebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 D (Rev 12/13) SHA (3 – 4 Years) Page 1 of 2 Staying Healthy Assessment 3 – 4 Years Child’s Name (first & last) Date of Birth Male Female Today’s Date In Child/Day Care? Yes No Person Completing Form Other
http://jwchinstitute.org/wp-content/uploads/2024/06/DHCS_7098_H_ENGLISH_SHA_Adult-Jun-2024.pdf black and brown leather bootsWebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 E (Rev 12/13) SHA (5 – 8 Years) Page 2 of 2 15 Does your child spend time with anyone who carries a gun, knife, or other weapon? No Yes Skip 16 Does your child always wear a helmet when riding a bike, skateboard, or scooter? Yes No Skip … black and brown leather purseWebState of California — Health and Human Services Agency Department of Health Care Services Staying Healthy Assessment 12 – 17 Years DHCS 7098 G (Rev 12/14) SHA (12 – 17 Years) Page 1 of 2 Name (first & last) Date of Birth Female Male Today’s Date Grade in School: Person Completing Form Parent Relative dave and buster houston txWebState of California – Health and Human Services Agency Department of Health Care Services DHCS 7098 A (Rev 12/14) SHA (0 – 6 Months) Page 1 of 2 Staying Healthy … black and brown leather glovesWebDHCS 7098 I (Rev 12/13) SHA (Senior) Page 1 of 2 . State of California — Health and Human Services Agency Department of Health Care Services . Clinic Use Only . … black and brown lace frontWebFeb 21, 2024 · DHCS 7098 A (12/14) - Staying Healthy Assessment: 0-6 Months Alt: Arabic, Armenian, Chinese, Hmong, Korean, Russian, Spanish, Tagalog, Vietnamese DHCS … black and brown kitchen tablehttp://jwchinstitute.org/wp-content/uploads/2014/04/DHCS_7098_A_ENGLISH_SHA_0-6Months.pdf black and brown lamp shade