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APPLICATION for HEALTH&nbsp Cdph Ca  Form

APPLICATION for HEALTH&nbsp Cdph Ca Form

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Video instructions and help with filling out and completing APPLICATION FOR HEALTH&nbsp Cdph Ca Form

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Instructions and help about APPLICATION FOR HEALTH&nbsp Cdph Ca

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 Health 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 on 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 a application infor

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