Form DHCS5077 C-3 - Facility Personnel Health Screening Report - California

What Is Form DHCS5077?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on January 1, 2015;
• The latest edition provided by the California Department of Health Care Services;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a fillable version of Form DHCS5077 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.