CAHAN (CAlifornia Health Alert Network) Enrollment Form 2025

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4.8 out of 5

44 votes

The document is an enrollment form for the California Health Alert Network (CAHAN) aimed at participants in San Luis Obispo County's public health alerting system. It requests personal and professional information to set up an account, ensuring confidentiality of the data provided. Participants must indicate their preferred methods of contact for alerts and can submit the form via email or fax.

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Click ‘Get Form’ to open the CAHAN Enrollment Form in the editor.
Begin by entering your name in the format LAST, FIRST M.I. This is essential for identification within the system.
Fill in your title, organization, and department to provide context about your role.
Complete your work address, including city and zip code, ensuring accurate location details.
Enter your work email address as it is required for communication regarding alerts.
Indicate any additional languages you speak, along with your professional licenses and specialties.
In the section provided, check at least three methods through which you can be reached and rank them accordingly using the larger boxes on the right.
Add any comments if necessary before finalizing your form.
Once completed, choose to either save and email the form or print it for faxing to ensure submission.

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Versions	Form popularity	Fillable & printable
2019	4.3 Satisfied (40 Votes)
2017	4.8 Satisfied (44 Votes)

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