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Source Plasma Donation Center (SPDC) Program Wadsworth Center New York State Department of Health Empire State Plaza Albany, NY 12237 www.wadsworth.org/regulatory/plasmaNotification of Change in Center

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How to fill out doh-5802

01

Obtain a copy of the doh-5802 form from the Department of Health.

02

Fill out the personal information section which includes your name, address, contact number, and date of birth.

03

Provide information about your medical history and any current health conditions.

04

Include details about the type of treatment or medication you are seeking approval for.

05

Sign and date the form before submission.

Who needs doh-5802?

01

Individuals who are seeking approval for a specific type of treatment or medication from the Department of Health.

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What is doh-5802?

doh-5802 is a form used for reporting certain health information to the relevant authorities.

Who is required to file doh-5802?

Healthcare providers and facilities are required to file doh-5802.

How to fill out doh-5802?

doh-5802 can be filled out electronically or manually, following the instructions provided on the form.

What is the purpose of doh-5802?

The purpose of doh-5802 is to ensure accurate and timely reporting of health data for analysis and public health purposes.

What information must be reported on doh-5802?

Information such as patient demographics, diagnosis, treatment, and outcomes must be reported on doh-5802.

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