Get Ca Dhcs 5999 2020-2026

The CA DHCS 5999 form is essential for individuals or organizations seeking to extend their license or certification through the Department of Health Care Services in California. This guide provides clear, step-by-step instructions for completing the form online, ensuring all necessary information is accurately submitted.

Follow the steps to successfully complete the CA DHCS 5999 online form.

1. Press the ‘Get Form’ button to obtain the form and open it in the online editing interface.
2. Complete the Provider Number field by entering your license or certification number.
3. Fill in the Legal Entity Name, ensuring it matches your official documentation.
4. Enter the Mailing Address, including Street, City, State, and Zip Code.
5. Provide a valid Phone number where you can be reached.
6. Input the Facility Name and its corresponding address details.
7. Specify the Type of Organization by selecting one of the options provided, such as profit corporation or nonprofit corporation.
8. Indicate the Type of Service(s) provided by checking the relevant boxes for each service offered.
9. For residential facilities, complete the Treatment/Recovery Capacity and include additional required documentation such as DHCS 5050 and 5086.
10. Review your information for completeness to prevent delays in processing.
11. Once all sections are filled out, print the form, sign it in blue ink, and gather all additional items required for submission.
12. Submit your completed form with applicable fees via mail to the designated department address.

Start completing your CA DHCS 5999 online today to ensure your license or certification remains current.