Applicants must submit copies of their certificates of completion with the CDPH 283 G to verify the In-Service Training/CEU requirement has been met.
Other documents: no other documentation will be accepted for the In-Service Training/CEU verification purpose.
Effective date: due to the lapse in certification the effective date will be changed to the date the application was renewed.
Delinquent status: individuals in a delinquent status may not hold himself or herself out to be a CHT until the certificate is renewed and in active status.
Address change: certificate holders shall notify CDPH within sixty (60) days of any change of address.
Name change: if requesting a name change, submit legal verification of the change (marriage certificate, divorce decree, or court documents).
| Question | Answer |
|---|---|
| Form Name | Form CDPH 283 G |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 33 |
| Avg. time to fill out | 6 min |
| Edition | 7/2024 |
| Issuing agency | California Department of Public Health |
| Where to send | Healthcare Workforce Branch (HWB) MS 3301, P.O. Box 997416 Sacramento, CA 95899-7416 |
| Other names | CDPH 283 G, CDPH 283G, CHT renewal application, Certified Hemodialysis Technician Renewal Application |
| Official source | Form CDPH 283 G (Rev 7/2024), California Department of Public Health |
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