Please rate Form Cdph 183 02-20
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Where to send: mail or fax the form to the California Department of Public Health Licensing and Certification Program, Aide and Technician Certification Section.
Other forms: do not send any other forms with this form.
Registered Nurse (RN): signs to certify that the students listed have successfully completed an approved HHA Training Program, and qualify for HHA certification.
Public address: required, and subject to Public Records Act request release.
SSN: if you use an invalid SSN, your application process may be delayed.
| Question | Answer |
|---|---|
| Form Name | CDPH 183 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 252 |
| Avg. time to fill out | 42 min |
| Edition | 02/20 |
| Where to send | Aide and Technician Certification Section (ATCS), California Department of Public Health |
| Who signs | A Registered Nurse (RN) responsible for the HHA training program |
| Other names | CDPH 183, CDPH183, LAB 183, LAB183, Form CDPH 183, California CDPH 183, Home Health Aide (HHA) Certification List |
| Official source | CDPH 183 (Rev 02/20), California Department of Public Health |
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Please rate Form Cdph 183 02-20
