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HEALTH LICENSING OFFICE 700 Summer St. NE, Suite 320, Salem, OR, 97301 Phones: 5033788667 Fax: 5033709004 www.oregon.gov×OHA×HBO Email: HBO.info state.or.us Print Form Authorization Holder Information
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How to fill out the HLO information update form:

01
Begin by gathering all the necessary documents and information. This may include personal identification documents, contact information, and any relevant certifications or qualifications.
02
Carefully read through the form instructions provided. Make sure you understand the purpose of the form and the specific information that needs to be updated.
03
Start filling out the form by entering your personal details, such as your full name, address, phone number, and email address. Ensure that you provide accurate and up-to-date information.
04
If there is a section for employment history or educational background, provide the relevant details accordingly. Include the names of the organizations you have worked for or attended, the dates, and any relevant job titles or degrees obtained.
05
If the form requires you to update your qualifications or certifications, provide the necessary information in the designated sections. This may include the name of the certification, the issuing organization, the date obtained or renewed, and any relevant license numbers.
06
Double-check all the information provided before submitting the form. Ensure that there are no spelling errors or inaccuracies in the details provided.

Who needs the HLO information update form:

01
Individuals who have experienced changes in their personal details such as name, address, phone number, or email address, need to fill out the HLO information update form. This form allows them to provide updated contact information to the relevant authorities.
02
Professionals who have recently obtained new qualifications, certifications, or licenses may also need to fill out the form to update their information in the HLO database. This ensures that their credentials are up to date and accurately represented.
03
Individuals who have changed employers or educational institutions should fill out the HLO information update form to reflect this change. This allows the HLO to keep track of professionals' current employment or enrollment status.
Note: The specific requirements and process for filling out the HLO information update form may vary depending on the jurisdiction or organization. It is essential to review the provided instructions and contact the relevant authority if you have any questions or need further guidance.
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The HLO information update form is a document used to update or modify information related to a Health Licensing Office (HLO) license or registration.
Anyone holding a HLO license or registration who needs to update their information is required to file the HLO information update form.
The HLO information update form can be filled out online on the Health Licensing Office website or by submitting a physical copy through the mail.
The purpose of the HLO information update form is to ensure that all information related to a HLO license or registration is accurate and up to date.
The information that must be reported on the HLO information update form includes personal details, contact information, license number, and any changes to the licensee's circumstances.
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