Ancing high quality, safe medical care. Gavin Newsom, Governor, State of California Business, Consumer Services and Housing Agency Department of Consumer Affairs HEALTH FACILITY/PEER REVIEW REPORTING FORM (Required by Section 805 of the California Business & Professions Code) NOTE: Certain actions, with respect to staff privileges, membership or employment of physicians, podiatrists, licensed midwifes and physician assistants must be reported to the Medical Board of California when they ar.
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How to fill out the CA ENF-805 online
The CA ENF-805 form is essential for reporting specific actions taken regarding medical staff privileges, membership, or employment for medical professionals in California. This guide provides step-by-step instructions to help you successfully complete the form online.
Follow the steps to fill out the CA ENF-805 form with ease.
- Click 'Get Form' button to access and open the CA ENF-805 form in your online editing tool.
- Begin by selecting the type of reporting entity you represent. Check the appropriate box for options such as Health Care Facility or Clinic, Professional Society, Ambulatory Surgical Center, Health Care Service Plan, or Medical Group or Employer.
- Complete the licentiate section by providing the name and license number of the physician, podiatrist, licensed midwife, or physician assistant involved in the action being reported.
- Ensure all signatures are collected from the Chief Executive Officer/Medical Director/Administrator and Chief of Medical Staff, including the corresponding dates.
Complete your CA ENF-805 form online today for a seamless reporting experience.
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