Get Cdph Form Afl 06 33

Filling out the Cdph Form Afl 06 33 online is an essential task for hospitals seeking temporary permission for increased patient accommodations during critical situations. This guide will provide you with comprehensive steps to successfully complete the form and submit your request.

Follow the steps to fill out the Cdph Form Afl 06 33 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the district office name where the request is being submitted. This is important for routing your request correctly.
3. Next, enter the date of your request. This date will serve as the official timestamp of your submission.
4. Fill in the facility name, ensuring that it matches the name registered with the Department of Health Services.
5. Provide the facility phone number. This allows for direct communication regarding your request.
6. List the facility address accurately, as this is essential for any follow-up correspondence.
7. Include the facility fax number where notification of approval or denial will be sent.
8. Identify the contact person for this request, ensuring clear lines of communication.
9. Write a brief description of the conditions necessitating increased patient accommodations. Be specific about the situation.
10. Indicate the duration of the request by providing an approximate number of days necessary for increased accommodations.
11. Detail the specific accommodations being requested. Clearly outline the needs of your facility.
12. Review the considerations for approving the request and check the appropriate box indicating if it pertains to a disease outbreak or an emergency situation.
13. Exhausting available alternatives is required before submitting your request. Check all that apply in the provided sections.
14. Confirm that you have plans in place for adequate staff, equipment, and space as required by the form.
15. After completing all sections, be sure to save your changes. You can then download, print, or share the completed form as needed.

Complete and submit your Cdph Form Afl 06 33 online to ensure timely processing of your request.