Get Cnahhacht Form

Filling out the Cnahhacht Form online is an important process for reporting misconduct within the healthcare system. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the Cnahhacht Form online.

1. Click the ‘Get Form’ button to access the Cnahhacht Form and open it for editing.
2. Begin by providing your personal information in the 'From reporting party' section. This includes your name, address, and telephone number.
3. Enter the date you are sending the form to the California Department of Public Health.
4. In the section for the individual being reported, fill in the name of the CNA/HHA/CHT, certification number, and if applicable, their complaint number.
5. Provide your social security number and any known aliases for the person being reported.
6. Input the telephone number and address of the individual along with their city, state, and ZIP code.
7. If you are not the complainant but a reporting party, provide the name and relationship of the complainant, and their contact information.
8. Indicate whether you are requesting anonymity by selecting 'Yes' or 'No'.
9. Describe the incident in detail, including the date it occurred. If more space is needed, continue on the back of the form.
10. If available, attach any supporting documentation, such as investigation reports, witness statements, or past incident records.
11. Fill in the employer's details and any actions taken, such as termination, suspension, or none.
12. Note any investigations conducted by various agencies, including their details and outcomes.
13. Finally, review all entered information to ensure accuracy before saving changes, downloading, printing, or sharing the completed form.

Complete your documents online for a streamlined process.