Publication Order Form California Health Information Association Californiahia

Instructions and help about Publication Order Form California Health Information Association Californiahia

hi I'm going to guide you through the HS 215 a applicant individual information form the applicant individual information form is used by each individual to capture their involvement now or in the past with any health or community care facility as part of the application package for licensure the provider must identify all individuals involved in their corporation limit liability company LLC or limited partnership LP etc tip this includes owners stockholders officers board members managers members administrator etc the HS 215 a form is a three-page form broken up into seven sections each section is required to be filled out and the information is used to verify compliance with CDP H health and safety code laws during this demonstration I will provide an overview of the information that's required for each section I will use the term facility when referring to a clinic or agency I will also use the term CA B moon' referring to the centralized applications branch let's begin on page 1 yo