Get Ca Cdph 283 C 2019-2025

The CA CDPH 283 C form is essential for renewing or reactivating certifications for certified nurse assistants and home health aides in California. This user-friendly guide provides clear instructions to help you successfully complete the form online.

Follow the steps to fill out the CA CDPH 283 C form effectively.

1. Press the ‘Get Form’ button to access the CA CDPH 283 C form and open it in your online editor.
2. Begin filling out SECTION I by selecting the type of request: CNA Renewal, HHA Renewal, or CNA Reactivation. Enter your certificate numbers as needed.
3. Complete SECTION II by providing your last name, first name, middle initial (MI), date of birth, and public address. Ensure your social security number or Individual Taxpayer Identification Number (ITIN) is entered accurately.
4. Indicate your phone number and email address in SECTION II, checking the box if your number is a cell phone.
5. Proceed to SECTION III and answer the required questions about criminal convictions and health-related disciplinary actions, providing details as necessary.
6. In SECTION IV, if applying for dual certification, complete the questions specific to HHA or CNA, regarding continuing education or training requirements.
7. Next, populate SECTION V if applicable, detailing your employment history as a CNA or HHA, including facility name, address, and dates of employment.
8. If you are a CNA applicant who did not meet renewal requirements, complete SECTION VI by indicating whether you wish to reactivate your certificate.
9. Finally, complete SECTION VII by certifying the application with your signature and date, ensuring all information is accurate and true.
10. Once the form is completed, you can save your changes, download, print, or share the completed CA CDPH 283 C form as needed.

Take the next step in your career by completing your CA CDPH 283 C form online today.