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Get and Sign Cdph 283a 2015-2022 Form

Get and Sign Cdph 283a 2015-2022 Form

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Certificates or nursing home administrator licenses. California Department of Public Health CDPH Licensing and Certification Program L C Aide and Technician Certification Section ATCS MS 3301 P. O. Box 997416 Sacramento CA 95899-7416 916 327-2445 FAX 916 552-8785 cna cdph. ca*gov State of California- Health and Human Services Agency CERTIFIED NURSE ASSISTANT CNA / HOME HEALTH AIDE HHA IN-SERVICE TRAINING / CONTINUING EDUCATION UNITS CEUs Printed Name of CNA/HHA Signature of CNA/HHA Certificate...
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The licensure and certification application form HS 200 is a multi-purpose form used for all facility types that are licensed by the Department of Public HEvalth centralized applications ranch the HS 200 is a four-page form broken up into sections application information licensee information facility agency or clinic information and property information each section is required to be filled out and the information is used by the provider to report to the centralized applications branch the type of application being submitted for processing during this instruction I will provide an overview of the information required for each section I will use the term facility when also referring to a clinic or agency I will also use the term cab when referring to the centralized applications branch let's begin page 1 you will notice in the top right corner of page 1 there is a box that states for departmental use only please do not enter any information in this box section an application information

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