PM 160 Information Only Form

All new medical providers are offered a Child Health and Disability Prevention (CHDP) Program orientation when they first become CHDP providers.  In-services are held either at the CHDP Program office or at the provider's office, depending on the number of people who need to be trained and CHDP staff availability.

CHDP Program orientation includes:

  • What's covered by CHDP
  • Who qualifies for CHDP
  • How often patients should have a CHDP exam (Bright Futures Periodicity Schedule)
  • How to fill out the Information Only PM160 form completely and correctly
  • Which forms to complete for non Medi-Cal patients
  • Where to send the Information Only PM160 forms
  • Referrals for specific questions regarding billing procedures and reimbursement

To request CHDP program in-service, please contact the Sacramento County CHDP Program.

CHDP Program
9616 Micron Ave Suite 670 Sacramento, CA 95827 (916) 875-7151