Get Ca Cdph 8391 2020-2026

The CA CDPH 8391 form is essential for individuals issued specific radiologic permits and certificates in California to report any changes in their name or address. This guide provides clear, step-by-step instructions on how to complete the form online effectively.

Follow the steps to fill out the CA CDPH 8391 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Indicate if you are taking a state examination by checking the appropriate exam category box (Supervisor/Operator, Radiologic Technologist, etc.).
3. Enter your current certificate or permit number in the designated field.
4. In the 'Previous Name and Address' section, fill in your previous name, address, city, state, and zip code accurately.
5. In the 'Current Name and Address' section, provide your new name, mailing address (including number and street or P.O. Box), city, state, and zip code.
6. Include your daytime telephone number and email address for communication purposes.
7. If you wish to keep your personal information private, consider providing an alternate address or phone number.
8. Sign and date the form to validate the information you have provided.
9. If you are requesting a duplicate copy of your permit or certificate, include a check or money order for $2, or $18 for Nuclear Medicine Technologist certificates, along with the form.
10. After ensuring that all fields are correctly filled, save your changes. You may then download, print, or share the completed form as needed.

Complete your CA CDPH 8391 form online today to ensure your information is up to date.