California
Statewide
Department Of Health And Human Services
Licensing And Certification
Last updated: 1/4/2021
Licensure And Certification Application {HS-200}
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Description
HS 200, LICENSURE & CERTIFICATION APPLICATION, this is a multi-purpose form used for all facility types that are licensed by the Department of Public Health centralized applications branch. Type or print clearly. Return original and maintain a copy for your records. The Licensee's name must be consistent throughout all documents submitted. Submit all supplemental paperwork requested to complete your application. Do not leave items blank. If not applicable, mark N/A. www.FormsWorkflow.com
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