Get Cdph Form 391

This guide provides clear instructions on how to complete the Cdph Form 391 online. By following these steps, you can ensure that all necessary information is accurately submitted for your Hemodialysis Technician/Patient Care Technician Training Program application.

Follow the steps to successfully fill out the Cdph Form 391

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering the 'ID number' if applicable, and the 'Date' on which you are completing the form.
3. In the 'Name of provider' section, provide the official name of the training program provider.
4. Fill in the 'Phone number' of the provider, ensuring it is accurate for follow-up communication.
5. Complete the 'Address' fields, including the number and street, city, county, state, and ZIP code associated with the provider.
6. In the 'Clinic/School Disclosure' section, print the name and title of the Medical Director and obtain their signature.
7. Repeat the previous step for the Registered Nurse (RN) Director, providing their name and title, and securing their signature.
8. In the 'Governing Body' section, print and have the Chairperson of the governing body sign the document.
9. Complete the 'RN Instructor Information' by providing the name of the RN instructor, their signature, and check the box confirming that a résumé is included.
10. Fill in the training information, detailing the length of theory and clinical training for each required topic.
11. If necessary, list any additional topics and their corresponding hours on a separate sheet.
12. Once all sections are completed, you can save your changes, download, print, or share the form as required.

Complete your Cdph Form 391 online today to ensure timely processing of your application.