Get the free cdph form 391 - cdph ca
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California Department of Public Health Licensing and Certification Program Aide and Technician Certification Section MS 3301 P.O. Box 997416 Sacramento, CA 95899-7416 (916) 327-2445 FAX: (916) 324-0109
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How to fill out cdph form 391
How to fill out cdph form 391:
01
Fill in the personal information section, including your full name, address, phone number, and date of birth.
02
Provide details about your current health status and any medical conditions you may have. Be truthful and accurate in your responses.
03
Indicate if you have any allergies or sensitivities to certain medications or substances.
04
Answer the questions regarding your vaccination history, including the vaccines you have received and the dates of administration.
05
If applicable, provide information about any previous adverse reactions to vaccinations.
06
Sign and date the form at the bottom to certify the accuracy of the information provided.
Who needs cdph form 391?
01
Individuals who are required to provide their vaccination history, such as healthcare workers, students, or individuals applying for certain jobs or programs, may need to fill out cdph form 391.
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It may also be required for individuals seeking medical treatment or entering certain healthcare facilities.
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The specific requirements for needing cdph form 391 can vary depending on the regulations and policies of the particular organization or institution involved.
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What is cdph form 391?
CDPH Form 391 is a form used in California for reporting certain infectious diseases and conditions to the California Department of Public Health.
Who is required to file cdph form 391?
Healthcare providers, laboratories, and facilities that identify or diagnose reportable diseases and conditions are required to file CDPH Form 391.
How to fill out cdph form 391?
To fill out CDPH Form 391, the provider must provide information including patient demographics, details of the reportable disease, and any other relevant clinical information as requested on the form.
What is the purpose of cdph form 391?
The purpose of CDPH Form 391 is to facilitate public health surveillance and epidemiology by collecting data on reportable diseases to help monitor trends, outbreaks, and the overall health of the community.
What information must be reported on cdph form 391?
Information that must be reported includes patient name, address, date of birth, disease or condition diagnosed, laboratory results, and the date of the diagnosis or test.
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