Specialty Providers

Contact Information

For CHDP Program
Toll Free #:    
1-800-993-2437
                         1-800-993-CHDP
Fax Number:  (626) 569-9350
Email: CHDP@ph.lacounty.gov
Address:

9320 Telstar Ave., Suite #226
El Monte, CA 91731   

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CHDP Forms
CHDP FORMS
CHDP Consent Formpdf icon
CHDP Newborn Referral Form (English)pdf icon
CHDP Newborn Referral Form (Spanish)pdf icon
Report of Health Examination for School Entry (English)pdf icon
Report of Health Examination for School Entry (Spanish)pdf icon
CCS Referral Processpdf icon
Specialty Referral, Guidelines and Tipspdf icon
 
CHDP Applications
CHDP Health Assessment Provider Applicationpdf icon
CHDP Health Assessment Provider Program Agreementpdf icon
CHDP Pre-Enrollment Application (English)pdf icon
CHDP Pre-Enrollment Application (Spanish)pdf icon
CHDP Pre-Enrollment Application (Arabic)pdf icon
CHDP Pre-Enrollment Application (Armenian)pdf icon
CHDP Pre-Enrollment Application (Cambodian)pdf icon
CHDP Pre-Enrollment Application (Chinese)pdf icon
CHDP Pre-Enrollment Application (Farsi)pdf icon
CHDP Pre-Enrollment Application (Hmong)pdf icon
CHDP Pre-Enrollment Application (Korean)pdf icon
CHDP Pre-Enrollment Application (Russian)pdf icon
CHDP Pre-Enrollment Application (Tagalog)pdf icon
CHDP Pre-Enrollment Application (Vietnamese)pdf icon
CHDP Supplemental Applicationpdf icon
CHDP Supplemental Application Instructionspdf icon
 
CHDP Brochures
CHDP Medical and Dental Health Check-upspdf icon
Newborn Hearing Screening Program (English)pdf icon
Newborn Hearing Screening Program (Spanish)pdf icon
Important Information for Parents To Be (English)pdf icon
Important Information for Parents To Be (Spanish)pdf icon
 
Pediatric TB Risk Assessment Questionnaire
Pediatric TB Risk Assessmentpdf icon
Pediatric TB Risk Assessment User Guidepdf icon
TB Screening Mandates for Schoolspdf icon
 
Nutrition Assessment
What Does Your Child Eat? Ages Birth-Eight (English)pdf icon
What Does Your Child Eat? Ages Birth-Eight (Spanish)pdf icon
What Do You Eat? Ages 8-21 (English)pdf icon
What Do You Eat? Ages 8-21 (Spanish)pdf icon
 
Childhood Lead Poisoning
Standard of Care and Potential Sources of Lead pdf icon
California Management Guidelines on Childhood Lead Poisoning for Health Care Providerspdf icon
Blood Lead Test and Anticipatory Guidancepdf icon
 
 
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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
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