This page will be updated as more information becomes available.
All Plan Letters (APLs)
Visit Department of Health Care Services (DHCS) to review the APLs listed below.
- APL 20-006
- APL 15-023
- APL 14-005
- APL 14-004
- APL 13-003
Resources
Medical Record Review Provider Training
General MRR Resources
Criteria
Format
Criteria
A. Member Identification
B. Personal Biographical Information
C. Emergency Contact
D. Medical Record Maintenance
E. PCP Assignment
F. Primary Language & Linguistic Service Needs
G. Medical Interpretation
H. Notice of Privacy
Documentation
Criteria
A. Allergies
B. Chronic Problems/Significant Conditions
C. Medication List
D. Consents
E. Advance Health Care Directive
F. Medical Record Entities
G. Medical Documentation Errors
Coordination of
Care Criteria
A. History of Present Illness
B. Diagnoses
C. Treatment Plans
D. Follow-Up Instructions
E. Unresolved or Chronic Problems
F. Practitioner Review
G. Evidence of Follow-Up
H. Patient Recall
Pediatric Preventive
Services Criteria
A. Initial Health Appointment & Subsequent Comprehensive Health Assessment
B. Initial and Subsequent Member Risk Assessment
C. Well-Child Visit
-
C.1 Alcohol Use Disorder Screening & Behavioral Counseling
C.2 Anemia Screening
C.3 Anthropometric measurements
C.4. Anticipatory Guidance
C.5 Autism Spectrum Disorder(ASD) Screening
C.6 Blood Lead Screening
C.7 Blood Pressure Screening
C.8 Dental/Oral Health Assessment
C.9 Depression Screening
C.10 Developmental Disorder Screening
C.11 Developmental Surveillance
C.12 Drug Use Disorder Screening & Behavioral Counseling
C.13 Dyslipidemia Screening
C.14 Hearing Screening
C.15 Hepatitis B Virus Infection Screening
C.16 Hepatitis C Virus Screening
C.17 HIV Screening
C.18 Psychosocial/behavioral Assessment
C.19 Sexually Transmitted Infections
C.20 Sudden Cardiac Arrest & Sudden Cardiac Death Screening
Sudden Cadiac Arrest/Sudden Cardiac Death Screening Form
C.21 Tobacco Use ScreeningC.22 Tuberculosis Screening
C.23 Vision Screening
D. Childhood Immunizations
Adult & Preventative
Services Criteria
A. Initial Health Appointment & Subsequent Comprehensive Health Assessment
B. Initial and Subsequent Member Risk Assessment
C. Adult Preventive Care Screenings
- C.1 Abdominal Aneurysm Screening
- C.2 Alcohol Use Disorder Screening & Behavioral Counseling
- C.3 Breast Cancer Screening
- C.4 Cervical Cancer Screening
- C.5 Colorectal Cancer Screening
- C.6 Depression Screening
- C.7 Diabetic Screening and Comprehensive Diabetic Care.
- C.8 Drug Use Disorder Screening & Behavioral Counseling
- C.9 Dyslipidemia Screening
- C.10 Folic Acid Supplementation
- C.11 Hepatitis B Virus Screening
- C.12 Hepatitis C Virus Screening
- C.13 High Blood Pressure Screening
- C.14 HIV Screening
- C.15 Intimate Partner Violence Screening for Women of reproductive Age.
- C.16 Lung Cancer Screening
- C.17 Obesity Screening & Counseling
- C.18 Osteoporosis Screening
- C.19 Sexually Transmitted Infection (STI) Screening & Counseling
- C.20 Skin Cancer Behavioral Counseling
- C.21 Tobacco Use Screening, Counseling and Intervention
- C.22 Tuberculosis Screening
D. Adult Immunizations
OB/CPSP
Preventive Criteria
A. Initial Comprehensive Prenatal Assessment (ICA)
B. First Trimester Comprehensive Assessment
C. Second Trimester Comprehensive Assessment
D. Third Trimester Comprehensive Assessment
E. Prenatal Care Visit Periodicity
F. Comprehensive Postpartum Assessment
Posted on June 30th, 2022 and last modified on July 14th, 2026.
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