CDPH HS215A - California Department of Public Health
CDPH HS215A - California Department of Public Health
This HS 215A form needs to be completed as part of an application package plus it needs to be completed for disclosure purposes when changes are reported in officers, directors, purchase of stock, etc., as required by law,
Forms: Licensing and Certification Program - California …
HS 610 (PDF) - Medically Underserved or Health Professional Shortage Areas *If you are having difficulty accessing any of these documents, please contact CDPH at (916) 558-1784 to request information in an alternate format.
AFL 23-24 - California Department of Public Health
Jul 1, 2023 · This AFL announces that the California Department of Public Health (CDPH) has revised Licensure and Certification Application (HS 200) (PDF) and Applicant Individual Information (HS 215A) (PDF) forms. The revised forms will be effective July 1, 2023.
Applicant Individual Information Form (HS 215A) - YouTube
This tutorial video guides applicants on how to complete the HS 215A form. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How …
Application Materials - Community-Based Adult Services
HS 200 (07/2023) – Licensure and Certification Application HS 215A (07/2023) – Applicant Individual Information HS 309 (10/2011) – Administrative Organization CDA IMS 33 (11/2023) – Balance ...
Blank HS 215A APPLICANT INDIVIDUAL INFORMATION [Title 22 California Code of Regulation (CCR) section 75025(b)] Submit a completed HS215A form for the Administrator Tips • Page 1, section A — The date of birth is an identifier, as several people may have the same name. This will ensure that each individual is associated with the correct
New Law Requires Certification of Medical Directors in Skilled …
Oct 13, 2021 · All free-standing SNFs are required to report the name and certification status of their medical director to CDPH no later than June 30, 2022. For this report a SNF must submit an HS 215A, resume, and proof of certification or progress toward certification to CDPH.
Licensing & Certification/OSHPD 3 - cpca.org
Applicant Individual Information (HS 215A) Administrative Organization Form (HS 309) Certification Form for Clinics and Freestanding Outpatient Clinic Services of a Hospital (CDPH 270)
Applicant Individual Information (HS 215 A) – Department of …
Download Applicant Individual Information (HS 215 A) – Department of Public Health (California) form. Formalu Locations. United States. Browse By State Alabama AL Alaska AK Arizona AZ Arkansas AR California CA Colorado CO Connecticut CT Delaware DE Florida FL Georgia GA Hawaii HI Idaho ID Illinois IL Indiana IN
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