Mber (if applicable): CDPH 8623 (10/17) Page 2 of 7 State of California – Health and Human Services Agency California Department of Public Health Radiologic Health Branch Section 6 – Personnel Qualifications a. Physician’s Qualifications. List all the physicians who interpret mammography exams for this facility. Use additional sheets if necessary. ABR, AOBR, or Supervisor/ RCPSC Certified in Check if California Supervisor/ Operator Diagnostic Lead Medical Board Operator Certificate/ .
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How to fill out the CA CDPH 8623 online
The CA CDPH 8623 is the application form for mammography facility and machine certification in California. This guide provides a clear and supportive step-by-step approach for users to successfully complete the form online.
Follow the steps to fill out the CA CDPH 8623 online effectively.
- Press the ‘Get Form’ button to access the CA CDPH 8623 form and open it in your preferred editing tool.
- Begin with Section 1 where you need to specify the facility status. Select the type of facility by checking the corresponding box such as 'Biopsy-Only Facility', 'ACR/MQSA Facility', or 'Other'. Also, indicate the reason for submission by checking all applicable options.
- In Section 2, provide comprehensive facility information. Include details such as the facility name, contact name, phone number, email address, and both the location and mailing addresses.
- Proceed to Section 3 to fill out the facility's mammography accreditation history. Indicate whether you have previously applied for FDA MQSA certification and if your facility’s accreditation status has been denied or revoked.
- In Section 4, detail the facility procedure information, specifically the number of various mammography procedures performed.
- Fill out Section 5 by providing any associated program information, including participation in the Every Woman Counts Program.
- Section 6 requires personnel qualifications. List all physicians, technologists, and physicists, ensuring to include their qualifications and certification details.
- For Section 7, provide information about the mammography equipment used, including the machine listing and specifications.
- Attach the medical physicist report required in Section 8, ensuring it meets the necessary evaluation criteria.
- Complete Section 9 by acknowledging and certifying the information provided in the form. Obtain necessary signatures from the facility owner or lead interpreting physician.
- Finally, save changes to the completed form. You may download and print a copy for your records or share it per the submission requirements.
Take the next step and fill out the CA CDPH 8623 online today.
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What is the phone number for CDPH licensing and certification?
The phone number for the California Department of Public Health Licensing and Certification division is available on their website. This direct line allows you to connect with staff who can help answer your questions about CA CDPH 8623. It’s recommended to call during business hours for the best chance of a quick response and effective assistance.
How do I contact the California Department of Public Health Licensing and Certification verification?
For inquiries related to the Licensing and Certification division of the California Department of Public Health, you can reach out directly through their designated phone line or email. They maintain specific locations for verification services, making it easier for you to get the necessary support. When contacting them about CA CDPH 8623, include any pertinent details to expedite your request.
How do I contact the California Department of Public Health?
To contact the California Department of Public Health, you can visit their official website for the most accurate information. They provide various contact options, including phone numbers, email addresses, and a physical mailing address. If you specifically need information related to CA CDPH 8623, be sure to reference that in your communication to receive the most relevant assistance.
What is the email format for CDPH CA Gov?
The typical email format for contacting CDPH in California is usually name@cdph.ca. For specific departments related to your inquiries, check their official website for any variations. This format helps in reaching out to the right personnel regarding questions linked to CA CDPH 8623.
How long does it take for CDPH to approve a license?
The approval timeline for a license by the CA CDPH can vary based on several factors, including the type of license and the completeness of your application. Generally, applicants should anticipate a waiting period that may range from a few weeks to several months. Ensuring your application is thorough can expedite the process regarding CA CDPH 8623.
Is CDPH the same as DHCS?
CDPH and DHCS serve different roles within California's health framework. CDPH is responsible for public health initiatives, while DHCS focuses on managing health care programs. Clearing up this distinction is beneficial, especially when seeking information regarding CA CDPH 8623 and its implications for health services.
How do I contact CA DHCS?
To contact CA DHCS, you can access their website for official contact information. They maintain a list of phone numbers and email correspondence dedicated to specific departments. For inquiries related to CA CDPH 8623, reaching out to DHCS ensures you connect with the right resources that cater to your particular needs.
How do I contact CDPH in California?
To contact the CA CDPH, you can visit their official website where they provide various contact methods, including phone numbers and email addresses. Additionally, they have an online form for inquiries, which can be particularly helpful. Direct communication ensures that your questions regarding CDPH 8623 and related matters receive prompt attention from skilled professionals.
What is the Department of Radiation Safety in California?
The Division of Radiation Safety and Environmental Management (DRSEM) protects and improves the health of all California residents through its environmental programs including radiation safety, inspection, laboratory testing, and regulatory activities.
How do I contact the CDPH radiologic health branch?
For information or access to your records, contact the Certification Support Unit at the California Department of Public Health, Radiologic Health Branch (CDPH-RHB), MS 7610, P.O. Box 997414, Sacramento, CA 95899-7414, (916) 327-5106.
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