Lab 183 12 09 2026

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The document is a certification form from the California Department of Public Health (CDPH) for Home Health Aide (HHA) Training Programs. It outlines the process for submitting student data to the Aide and Technician Certification Section (ATCS) upon completion of HHA training. The form requires details such as the school's information, program dates, and student personal information including Social Security Numbers, which are mandatory for certification purposes.

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Click ‘Get Form’ to open lab 183 12 09 in the editor.
Begin by entering the name of the school or agency presenting the HHA training program in the designated field.
Fill in the mailing address, including street name or P.O. Box, city, state, and ZIP code.
Indicate the start and completion dates of the program in their respective fields.
Provide the HHA school code and ensure all information is accurate before proceeding.
In the certification section, have a Registered Nurse (RN) sign and provide their telephone number.
List each student’s last name, first name, middle initial, mailing address, city, social security number, and telephone number in the provided fields. Repeat for up to twelve students as necessary.

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cdph lab form 183

LAB 182 Cdph LAB 182 LAB 193 LAB 116 form CMS 116 CDPH Center for Laboratory Sciences Lab 144a Department of Health Laboratory

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