Get Ca Dhcs 1051 2019-2025

The CA DHCS 1051 form is essential for conducting civil rights compliance reviews by health care agencies and facilities in California. This guide provides inclusive, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the CA DHCS 1051 form online

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In the first section, provide the name of your agency or facility, Medi-Cal provider number, address, county, ZIP code, and the number of patients. Additionally, enter the administrator's name and telephone number along with the contact information for the staff member providing the information.
3. Fill out the section regarding the type of agency or facility. Check the appropriate boxes for the various types such as General Acute Care Hospital, Skilled Nursing Facility, or others as applicable.
4. In the ownership section, indicate the type of control or ownership such as State government, voluntary nonprofit, or proprietary. Provide any specific details as necessary.
5. Complete the current census section by filling in licensed bed capacity, number of residents, and other relevant details about the facility's services.
6. In the bilingual services section, state whether you have bilingual staff, and if so, provide their names, languages spoken, and shifts.
7. For services available to disabled employees or residents, indicate whether the facility uses sign language interpreters, text telephones, or other auxiliary aids.
8. Next, fill out the ethnic and disability composition of staff. Provide the number of staff from various ethnic backgrounds and disability statuses.
9. In the resident characteristics section, provide the current number of residents and any limitations on facility usage based on membership in defined groups.
10. Conclude by reviewing all sections for accuracy, then save changes, download, print, or share the completed form as necessary.

Complete your CA DHCS 1051 form online today to ensure compliance and support equitable access.