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Mobile Food Facility Route Sheet
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*NOTIFY THE HEALTH DEPARTMENT REGARDING ANY CHANGES. **Updated Route Sheets are required at least ... 562-570-403 ROUTE SHEET MOBILE FACILITY DBA (Truck name): _____________________________________________________URL/globalassets/health/media-library/documents/inspections-and-reporting/forms/environmental-health/route-sheet-edit-7-12-10
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English
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the HIPAA Privacy Rule In response to recent changes in law and regulation, including updates to support ... asked to sign your name and indicate your physician. We may also call you by name in the waiting roomURL/globalassets/health/media-library/documents/services/directory/about-us/notice-of-privacy-practices---english
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BIH Referral Form
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___ *First Name: ______________________ Middle Name:_____________________ *Last Name:_______________________ ... Name:_______________________ Maiden Name: _____________________ *Participant’s DOB: _____ /______ /______URL/globalassets/health/media-library/documents/services/directory/maternal-and-child-health/--bih--recruitment-form-2016
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Clinic Fees
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vaccine and medication fees to respond to pricing changes. II. VITAL STATISTICS Fees charged ... DEPARTMENT: HEALTH & HUMAN SERVICES PerFeeDescriptionFee Name Type ENVIRONMENTAL HEALTH SERVICES FOOD PROGRAMURL/globalassets/health/media-library/documents/services/clinics/heath-and-human-services-fee-schedule-fy2014-05202014
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Community Resource List
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life of Long Beach residents. To report any changes or additions to the list, please contact, Cheryl ... Long Beach Community Resources List 12-20-13 NAME PURPOSE OF GROUP CONTACT PERSON TELEPHONE # AfricanURL/globalassets/health/media-library/documents/healthy-living/community/community-resource-list/long-beach-resource-list-updated-12-20-13
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PHN REFERRAL Form
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PHN REFERRAL Form ... Public Health Nursing Referral NAME(S) OF DATE MEDI-CAL/SS#: CHILD(REN) ... REFERRED IF CHILDREN: MOTHER’S NAME: FATHER’S NAME: ADDRESS: PHONE # PRIMARY LANGUAGE:URL/globalassets/health/media-library/documents/services/directory/public-health-nursing/phn-referral-form-2013
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California Food Handler Card Law Frequently Asked Questions
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Food Handler Card Law. SB 303 makes technical changes to the Food Handler Card Law and requires training ... issued to, regardless of whether the food handler changes employers during that period or whether the foodURL/globalassets/health/media-library/documents/services/directory/food-safety-and-inspections/ca-food-handler-card-guidelines-11-21-2011
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Food Safety Program
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BUREAU OF ENVIRONMENTAL HEALTH FOOD SAFETY PROGRAM Our goal is to ensure the food ... convenience stores. ❍ PLAN CHECK Any new, remodel, or changes made to a food facility requires plan and specificationURL/health/inspections-and-reporting/inspections/environmental-health-bureau/food-safety-program/
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__________________ MM/ DD/YYYY FIRST NAME*: LAST NAME*: MIDDLE NAME: DATE OF BIRTH*: __________________ ... PROVIDER* LABORATORY* PROVIDER NAME CLIA# LAB NAME ADDRESS CITY STATE ZIP CODE ADDRESSURL/globalassets/health/media-library/documents/diseases-and-condition/reporting-requirement/hiv--aids/standardhivlabreportform-june2015fillable
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Cottage Food Labeling Power Point
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General Labeling Requirements • 1. Common name of food • 2. The name of Cottage Food Operation • 3. Address ... 1. Product name. Ex: Chocolate Chip Cookie with Walnuts, or Twinkie (Fanciful Name) and must haveURL/globalassets/health/media-library/documents/services/directory/food-safety-and-inspections/cottage-foods/cottage-food-labeling
