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This version of the form is not currently in use and is provided for reference only. Download this version of
Form CDPH611
for the current year.
Form CDPH611 Licensing and Certification for an Affiliate Primary Care Clinic Application - California
What Is Form CDPH611?
This is a legal form that was released by the California Department of Public Health - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of Form CDPH611?A: Form CDPH611 is used for licensing and certification of an Affiliate Primary Care Clinic in California.
Q: What is an Affiliate Primary Care Clinic?A: An Affiliate Primary Care Clinic is a clinic that operates in conjunction with a licensed primary care clinic to provide expanded services.
Q: Who needs to complete Form CDPH611?A: Any organization or entity that wishes to establish or operate an Affiliate Primary Care Clinic in California needs to complete this form.
Q: What information is required in Form CDPH611?A: The form requires information about the applicant's organization, the proposed clinic location, services to be provided, personnel, and compliance with regulatory requirements.
Form Details:
- Released on July 1, 2011;
- The latest edition provided by the California Department of Public Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CDPH611 by clicking the link below or browse more documents and templates provided by the California Department of Public Health.
Download Form CDPH611 Licensing and Certification for an Affiliate Primary Care Clinic Application - California
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