Form Cdph 391 PDF Details

For any individual aiming to step into the world of healthcare specifically within the niche of dialysis, understanding the CDPH 391 form is crucial. Issued by the California Department of Public Health, under the umbrella of the State of California - Health and Human Services Agency's Licensing and Certification Program, this form functions as the backbone for getting recognized as a certified Hemodialysis Technician or Patient Care Technician. With specifics laid out for both the applicant and the training provider, the form requires detailed information from the application's provider including the name and contacts of the institution, medical directors, and the registered nurse director alongside their signatures, which symbolizes the acknowledgment and responsibility towards the offered training program. The form meticulously outlines the minimum required hours for theory and clinical training, highlighting crucial areas such as principles of dialysis, care for patients experiencing kidney failure, dialysis procedures, possible complications, water treatment processes, infection control, safety measures, and optional dialyzer reprocessing. This diligently structured approach ensures that the training program is not only comprehensive but adheres to standards that prepare students for real-world challenges in patient care within the dialysis field. This foundational step serves as a gatekeeper in maintaining high standards of care for patients with kidney failure, emphasizing the form's role in safeguarding health and wellness through adequate training.

QuestionAnswer
Form NameForm Cdph 391
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescdph form 391, Licensing, cdph 391 form, reprocessing

Form Preview Example

California Department of Public Health

State of California - Health and Human Services AgencyLicensing and Certification Program

Aide and Technician Certification Section

MS 3301

P.O. Box 997416

Sacramento, CA 95899-7416

(916) 327-2445 FAX: (916) 324-0109

HEMODIALYSIS TECHNICIAN/PATIENT CARE TECHNICIAN

TRAINING PROGRAM APPLICATION

FOR OFFICE USE ONLY

ID NUMBER:

Name of provider:

Date:

Phone number:

()

Address (number, street)

(City)

(County)

(State)

(ZIP code)

Provider:

School

Clinic

CLINIC/SCHOOL DISCLOSURE

Print Name and Title of Medical Director

Signature of Medical Director

Print Name and Title of Registered Nurse (RN) Director

Signature of Registered Nurse (RN) Director

Governing Body

Signature of Chairperson of Governing Body

 

RN INSTRUCTOR INFORMATION

 

 

CDPH USE

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of RN (Print)

Signature of RN

Resumé Included

Approval

 

 

 

 

 

 

 

1

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

2

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

3

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

4

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

5

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

6

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

7

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

8

 

 

Yes

No

Yes

No

 

 

 

 

 

 

 

CDPH 391 (06/11)

Page 1 of 2

Minimum of eighty (80) hours of theory and a minimum of two hundred (200) hours of clinical. The following topics must

be included in the training:

NAME OF CURRICULUM

 

Length of

 

Length of

Theory Training

Clinical Training

 

 

 

 

 

 

 

 

Principles of dialysis

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

Care of patients with kidney failure; including interpersonal skills

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

Dialysis procedures and documentation; including initiation, proper

 

 

Hrs.

 

 

Hrs.

 

 

 

 

cannulation techniques, monitoring and termination of dialysis

 

 

 

 

 

 

 

 

 

 

 

Possible complications of dialysis

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

Water treatment and dialysate preparation

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

Infections control

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

Safety

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

Dialyzer reprocessing; if applicable

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List other topics and hours (use a separate sheet if necessary)

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hrs.

 

 

Hrs.

 

 

 

 

 

 

 

 

 

 

 

 

CDPH 391 (06/11)

Page 2 of 2

How to Edit Form Cdph 391 Online for Free

cdph391 can be filled out in no time. Simply make use of FormsPal PDF tool to do the job right away. The editor is consistently improved by our staff, receiving new awesome features and turning out to be greater. Getting underway is easy! Everything you should do is take the following simple steps below:

Step 1: First, access the tool by clicking the "Get Form Button" above on this site.

Step 2: With our advanced PDF file editor, it's possible to do more than merely complete blanks. Edit away and make your forms seem high-quality with custom textual content put in, or fine-tune the file's original input to excellence - all that comes with the capability to insert any kind of photos and sign the PDF off.

This PDF form requires specific details to be filled out, therefore be sure you take some time to type in what's required:

1. When submitting the cdph391, make certain to include all of the necessary fields in the associated area. This will help facilitate the work, which allows your information to be handled swiftly and appropriately.

Filling out part 1 in interpersonal

2. When the prior selection of fields is filled out, go to type in the applicable information in these - Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, Yes, and Yes.

Yes, Yes, and Yes of interpersonal

3. Completing Principles of dialysis, Care of patients with kidney, Possible complications of dialysis, Water treatment and dialysate, Infections control, Safety, Dialyzer reprocessing if, Hrs, Hrs, Hrs, Hrs, Hrs, Hrs, Hrs, and Hrs is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Learn how to prepare interpersonal stage 3

It's simple to make an error when completing the Hrs, for that reason make sure that you take a second look prior to when you finalize the form.

4. You're ready to proceed to the next segment! In this case you'll get these Hrs, Hrs, Hrs, Hrs, Hrs, Hrs, Hrs, and Hrs blanks to do.

Step number 4 in filling in interpersonal

Step 3: Right after double-checking your form fields, click "Done" and you're good to go! Sign up with us today and instantly obtain cdph391, all set for downloading. All alterations made by you are preserved , which means you can edit the pdf at a later point if necessary. FormsPal is invested in the privacy of all our users; we always make sure that all personal data processed by our editor is kept protected.