Alabama dhr can form 2026

1. Click ‘Get Form’ to open the Alabama DHR CAN form in the editor.
2. Begin by entering the name of the person, agency, or organization requesting the clearance in the designated field.
3. Fill in the complete mailing address and telephone number, ensuring accuracy for communication purposes.
4. Optionally, provide an email address for further correspondence.
5. Print and sign your name along with the date in the appropriate section. A witness must also sign and date this form.
6. Indicate your category by checking all applicable boxes, such as Medicaid Rehab Provider if relevant.
7. Complete personal details of the individual being cleared, including their name, sex, race, date of birth, and current address.
8. List any aliases or prior names if applicable. Repeat this for spouse and children information as needed.
9. Finally, ensure that both you and a witness have signed before submitting your completed form to the appropriate department.

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