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CA CDPH 8391 2020 free printable template

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State of California Health and Human Services Agency California Department of Public Health Radiologic Health BranchREPORT OF NAME OR ADDRESS CHANGE California Code of Regulations, Title 17, Sections
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How to fill out CA CDPH 8391

01
Obtain a blank CA CDPH 8391 form from the California Department of Public Health website.
02
Fill in the 'Facility Information' section with the name and address of the facility.
03
Complete the 'Incident Information' section by providing details about the incident, including date, time, and type.
04
Include the names of individuals involved in the incident and their roles in the facility.
05
Describe the nature of the incident in the 'Description of Incident' section.
06
Fill out any additional required sections such as 'Follow-Up Actions' or 'Notification Information' as applicable.
07
Review the completed form for accuracy and ensure all required fields are filled.
08
Submit the completed form to the appropriate department as instructed on the form.

Who needs CA CDPH 8391?

01
CA CDPH 8391 is required for healthcare facilities in California that need to report specific incidents or unusual occurrences as mandated by state regulations.
02
It is necessary for administrators or staff responsible for compliance and incident reporting within these healthcare facilities.
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CA CDPH 8391 is a reporting form used in California for the surveillance and management of communicable diseases.
Healthcare providers, laboratories, and other entities reporting specific communicable diseases are required to file CA CDPH 8391.
To fill out CA CDPH 8391, provide accurate patient information, diagnosis, date of onset, and other relevant clinical data in the designated sections of the form.
The purpose of CA CDPH 8391 is to facilitate the collection of data on communicable diseases for public health surveillance and to inform prevention and control efforts.
Information that must be reported includes patient demographics, clinical details, disease specifics, and any relevant laboratory findings.
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