Ramento, CA 95899-7413 A-2 ADMINISTRATOR/DIRECTOR INFORMATION IDENTIFYING INFORMATION NAME: TITLE: E-MAIL ADDRESS: TELEPHONE NUMBER: ADDRESS: OTHER NAME(S) USED BY ADMINISTRATOR/DIRECTOR: EDUCATION THE HIGHEST GRADE LEVEL YOU COMPLETED 1 2 3 4 5 6 7 8 9 10 11 12: NAME AND LOCATION OF COLLEGE OR UNIVERSITY YES HIGH SCHOOL GRADUATE: COURSE OF STUDY NO COMPLETED SEMESTER QUARTER UNITS UNITS PASSED HIGH SCHOOL EQUIVALENCY TESTS: YES DATE DEGREE COMPLETED OBTAINED MANAGEMENT EXPERIENCE.
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How to fill out the CA DHCS 5082 online
The CA DHCS 5082 form is a key document used in the process of applying for licensing and certification within the state of California's Health Care Services. This guide will provide you with clear and comprehensive steps to fill out this form online, ensuring you have all the necessary information to complete it accurately.
Follow the steps to successfully fill out the CA DHCS 5082 online.
- Press the ‘Get Form’ button to access the CA DHCS 5082 and open it in the required editor.
- In the ‘Identifying Information’ section, fill out your full name, title, email address, telephone number, address, and any other names you may have used.
- Under the ‘Education’ section, indicate the highest grade level you have completed from 1 to 12. Provide the name and location of your college or university. If applicable, indicate whether you are a high school graduate and provide details of your course of study.
- In the ‘Management Experience’ section, list the type of management experience, your title, and the start date of your position.
- If you possess a professional license or certificate, answer ‘Yes’ and complete the subsequent fields detailing the type of license, issuing agency, and the dates it was held. If not, answer ‘No’.
- Move to the ‘Work Experience’ section, starting with your most recent job. Provide the name and address of your employer, your duties, and the dates you worked there.
- Finally, fill in the signature field, and indicate the date of completion. After reviewing all the information for accuracy, you can save your changes, download, print, or share the completed CA DHCS 5082 form.
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Mark Ghaly, MD, MPH Mark Ghaly was appointed Secretary of the California Health & Human Services Agency in early 2019 by Governor Gavin Newsom. In serving California, Dr. Ghaly has the privilege of working with partners across sectors and disciplines to improve the lives and life chances of ALL Californians.
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California Department of Health Care Services Agency overviewAnnual budgetUS$ 100 billion (2021-22)Agency executiveMichelle Baass, Director (effective September 10, 2021)Parent agencyCalifornia Health and Human Services AgencyWebsitewww.dhcs.ca.gov2 more rows
What is the role of California Department of Health Care Services?
The mission of DHCS is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. Our vision is to preserve and improve the overall health and well-being of all Californians.
Who is the director of the CA Dhcs?
About Director Michelle Baass DHCS supports the health of about 14 million Californians on Medi-Cal, the state's Medicaid program. Ms. Baass leads a team of more than 4,000 individuals at DHCS.
Is California DHCS Medicaid?
Medi-Cal is California's Medicaid program. This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources.
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