Starting July 1, 2025, HMDR Exemptees are only required to maintain a single Exemptee license per individual.
Multiple facilities: if you work at multiple HMDR facilities, this single license will apply to all those facilities.
One application: only submit one HMDR Exemptee License application per person.
Returned: unsigned or incomplete applications cannot be processed and will be returned.
New applicants only: if you have the requirements for 5A, please skip 5B.
Signature: after reading the instruction paragraph your signature is needed, please sign in full (no initials) and date.
| Question | Answer |
|---|---|
| Form Name | CDPH 8695 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 47 |
| Avg. time to fill out | 8 min |
| Edition | 07/2026 |
| Issuing agency | California Department of Public Health Food and Drug Branch |
| Who signs | The exemptee |
| Other names | CDPH 8695, CDPH8695, 8695, Form 8695, CDPH 8695 form, HMDR Exemptee License, Home Medical Device Retailer Exemptee License Application |
| Official source | CDPH 8695 (Rev 07/2026), California Department of Public Health Food and Drug Branch |
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