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Get Ca Dhcs 5050 2013
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How to fill out the CA DHCS 5050 online
The CA DHCS 5050 form is essential for documenting staff information in health care facilities. This guide will provide you with step-by-step instructions to complete the form accurately and efficiently online.
Follow the steps to fill out the CA DHCS 5050 online effectively.
- Press the ‘Get Form’ button to access the CA DHCS 5050 form and open it in your editor.
- In the 'Facility Name' field, enter the name of the health care facility for which you are providing staffing data.
- Provide the 'Provider #' in the designated field to identify the facility.
- Indicate whether the staff member is 'Certified,' 'Registered,' or 'Licensed' by selecting 'Yes' or 'No' in the respective fields for each staff member listed.
- For each staff member, fill in their 'Title' and 'Scheduled hours per week' to reflect their employment status.
- If applicable, enter the 'Date Hired' and 'Last TB Test Date' for each employee.
- Record 'First Aid' and 'CPR' training dates, ensuring compliance with requirements for licensed facilities.
- For licensed personnel, specify their type (e.g., Psychologist, MFT) and document the effective and expiration dates of their licensure, certification, or registration along with the certification/registration number and organization.
- Continue filling out the remaining sections for additional staff members as necessary.
- Once all fields are complete, you may save your changes, download a copy, print it for your records, or share the form as required.
Start filling out your CA DHCS 5050 form online today.
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The number 800-430-4263 is associated with the California DHCS for various consumer services, including queries about medical services and patient support. When you call this number, you can gain insights and assistance relevant to your needs under the CA DHCS 5050 umbrella. It’s your direct line for clarity and guidance regarding state-sponsored health programs. Keeping this number handy can simplify your healthcare navigation.
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