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TITLE PAGE FLORIDA DEPARTMENT OF HEALTH DOH 16071102016INVITATION TO NEGOTIATE (ITN) FOR Identification Card and Call Center for Patients and Caregivers Office of Medical Marijuana Use Respondent

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How to fill out doh 16-071

01

To fill out the DOH 16-071 form, follow these steps:

02

Begin by reading the instructions provided on the form carefully.

03

Provide your personal information, including your name, address, and contact details, in the designated fields.

04

Specify the type of facility or service you are applying for or reporting on.

05

Answer all the questions and provide the required information accurately and honestly.

06

If applicable, provide information about any previous health department actions or deficiencies.

07

If necessary, attach any supporting documentation as indicated on the form.

08

Review the completed form to ensure all sections are filled out correctly.

09

Sign and date the form.

10

Submit the form as instructed, either in person, by mail, or electronically.

11

Keep a copy of the completed form for your records.

Who needs doh 16-071?

01

DOH 16-071 is needed by individuals or organizations who are applying for or reporting on a facility or service that falls under the jurisdiction of the Department of Health (DOH). This may include healthcare providers, medical facilities, service providers, licensed establishments, or any other entity regulated by the DOH. The specific requirements for needing DOH 16-071 will depend on the nature of the facility or service being provided and the applicable regulations.

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