Dhcs 5050-2026

1. Click ‘Get Form’ to open the DHCS 5050 in the editor.
2. Begin by entering the 'Facility Name' and 'Provider #' at the top of the form. Ensure accuracy as this information is crucial for identification.
3. In the 'Counselor Information' section, list all staff members. For volunteers, place a 'V' next to their names. Remember, at least 30% of counseling staff must be licensed or certified.
4. Fill in each employee's details including their name, title, scheduled hours per week, and certification/registration numbers. Be sure to include effective and expiration dates for licenses.
5. Complete the sections regarding CPR and First Aid certifications as required for licensed facilities. Indicate if they are certified or registered by marking 'Yes', 'No', or 'N/A'.

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