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CA CDPH 72R 2009 free printable template

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State of California Health and Human Services Agency California Department of Public Health Food and Drug Branch BIENNIAL MEDICAL DEVICE MANUFACTURING LICENSE RENEWAL APPLICATION PLEASE COMPLETE THIS FORM FULLY INCOMPLETE APPLICATIONS WILL BE RETURNED See page 2 for instructions 9. 31. Signature of Applicant Printed name Title Date PLEASE DO NOT WRITE BELOW THIS LINE. License Number Expiration Date Date Received Payment Type Amount CDPH 72R 01/13...
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How to fill out CA CDPH 72R

01
Obtain the CA CDPH 72R form from the official California Department of Public Health website.
02
Carefully read the instructions provided with the form.
03
Fill in the applicant's contact information accurately in the designated fields.
04
Provide details regarding the premises or facility related to the application.
05
Complete the sections regarding the type of regulation or service being requested.
06
If applicable, include any necessary supporting documents as outlined in the instructions.
07
Review all filled information for accuracy and completeness.
08
Sign and date the application at the designated spot.
09
Submit the completed form to the appropriate address or via the specified method.

Who needs CA CDPH 72R?

01
Individuals or organizations applying for a license, permit, or registration related to health facilities in California.
02
Existing health facility operators seeking to modify their current licenses or services.
03
Health-related businesses that require state approval to operate.
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CA CDPH 72R is a document used in California to report deaths and specify the cause of death, which is submitted to the California Department of Public Health.
The CA CDPH 72R must be filed by the attending physician, the coroner, or the medical examiner for individuals who have passed away under their care.
To fill out CA CDPH 72R, gather all necessary information about the deceased, including personal details, cause of death, and relevant medical history, then complete each section of the form accurately according to the provided instructions.
The purpose of CA CDPH 72R is to facilitate the accurate recording and reporting of deaths in California, which is important for public health statistics and epidemiology.
Information required on CA CDPH 72R includes the deceased person's demographics, medical history, time and location of death, and the cause of death as determined by the attending physician or coroner.
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