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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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CHDPWellChildDevelopmentalSurveillanceSurvey
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Patient Name: ____________________ Date: ____________________ CHDP Well-Child Developmental Surveillance ... concerns There have been no significant life changes in child's life recently (death, divorce, moveURL/globalassets/health/media-library/documents/services/directory/child-health-and-disability-prevention/chdpwellchilddevelopmentalsurveillancesurvey
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NGHA Required Documents
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24 hours prior to event’s commencement, of any changes occurring in locations, dates or times indicated ... CHECKLIST Name of Organization or Operator: ______________________________________________ Name of Owner:URL/globalassets/health/media-library/documents/services/clinics/public-health-laboratory/ngha-forms-for-lb-website
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DevelopmentalSurveillanceChecklist-1-5
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Patient Name: _________________________ DOB: _________________________ CHDP Well-Child Developmental ... dries hands and face; brushes teeth Help child name what he/she sees, hears, or does Separates fromURL/globalassets/health/media-library/documents/services/directory/child-health-and-disability-prevention/developmentalsurveillancechecklist-1-5
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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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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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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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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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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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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/
