Get (cht) Initial Application - Cdph Ca

This guide provides detailed, step-by-step instructions for completing the Certified Hemodialysis Technician (CHT) Initial Application through an online platform. By following these directions, users can ensure that their applications are filled out correctly and submitted efficiently.

Follow the steps to successfully complete the application.

1. Press the ‘Get Form’ button to access the document and open it in the editor for online completion.
2. Fill in your personal details in the designated fields, including your last name, first name, middle initial, sex, address, city, state, date of birth, and social security number. Ensure all information is accurate to avoid processing delays.
3. Indicate whether any health-related licensing or certification authority has taken adverse action against you by selecting 'Yes' or 'No.' If you answer 'Yes,' provide the type and number of license or certificate.
4. Complete the education section by confirming if you possess a high school diploma or equivalency and provide the details of the institution from which you obtained this. This includes the name, address, and telephone number of the institution.
5. In the training section, list the name and address of the CHT training program you completed, including the telephone number and provider number. Ensure to include the printed name and signature of the registered nurse trainer.
6. Provide information about the test or examination you passed, including the name, address, and telephone number of the examination provider, along with the provider number. Include the printed name and signature of the examination proctor and the date you passed the test.
7. Certify and sign your application by providing your signature and the date of signature. This affirms that the information is true and correct under penalty of perjury.
8. Once you have completed all sections, review your application for accuracy. After ensuring all details are correct, you can save changes, download, print, or share your completed form as necessary.

Begin your application process online today to ensure you are on track to become a certified hemodialysis technician.