Form Cdph 391 PDF Details

Cdph 391 is a California Department of Public Health form that must be completed by medical cannabis dispensaries and physicians. The form is used to track the sale or transfer of medical cannabis between the dispensary and the physician. Completing Cdph391 is required for both entities, and helps ensure that state regulations are being followed. This article will provide an overview of Cdph391, including what information is required on the form, and why it is important.

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

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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!

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