CDPH 8391 is a form used to notify the California Department of Public Health (CDPH) that an individual has died. The form must be completed and submitted within 10 days of the death, and can be filed electronically or by mail. CDPH will use the information provided on the form to track the number of deaths in California, as well as to determine which causes of death are most common. Completing and submitting CDPH 8391 is a requirement for funeral directors in California. The purpose of this blog post is to provide a brief overview of CDPH 8391, including what information is required, who needs to complete it, and when it must be submitted. We will also discuss some common mistakes made
| Question | Answer |
|---|---|
| Form Name | Cdph 8391 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Pursuant, Fluoroscopic, cdph8391, Technologist |
State of |
California Department of Public Health |
|
Radiologic Health Branch |
REPORT OF NAME OR ADDRESS CHANGE
California Code of Regulations, title 17, sections 30406 and 30537, requires any individual issued an
Pursuant to the California Code of Civil Procedure Section 1275, name change requests must be accompanied by a copy of a certified superior court order allowing the name change and a government issued picture ID, such as a driver’s license, military ID, or passport.
Mark only if you are in the process of applying/taking the following State examination:
Supervisor/Operator
Limited Permit
Nuclear Medicine Technologist
Radiologic Technologist
Fluoroscopic Radiologic Technologist
Mammographic Radiologic Technologist
Current Certificate/Permit Number _______________
PREVIOUS NAME AND ADDRESS:
Name __________________________________________
Address ________________________________________
City, State, Zip Code _________________________________________________________
CURRENT NAME AND ADDRESS:
Name _________________________________________
Address _______________________________________
City, State, Zip Code _________________________________________________________
Daytime Telephone
Signature_____________________________________________ Date________________
MAIL OR FAX TO:
California Department of Public Health
Radiologic Health Branch, MS 7610
P.O. Box Number 997414
Sacramento, CA
FAX (916)
Telephone (916)
Internet Address: http://www.cdph.ca.gov/programs/Pages/RadiologicHealthBranch.aspx
CDPH 8391 (4/11)