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Get Cdph 5000a

Approval Request Select the Request Check all at apply Tent use High patient volume Space conversion Other than tent use Bed use Over bedding Program Flex Request What regulation are you requesting program flexibility for For CDPH Use Only CDPH Licensing Certification Approval Permission Granted from to Permission Denied Briefly describe why request was denied in comments / conditions below Comments / conditions L C District Office Staff Signatur.

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