Form DHCS5104 Outpatient Fire Clearance - California

What Is Form DHCS5104?

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.

FAQ

Q: What is Form DHCS5104?
A: Form DHCS5104 is a form used to request outpatient fire clearance in California.

Q: Who needs to fill out Form DHCS5104?
A: Healthcare facilities that provide outpatient services in California need to fill out Form DHCS5104.

Q: Why is Form DHCS5104 required?
A: Form DHCS5104 is required to ensure that healthcare facilities meet fire safety standards for outpatient services.

Q: How do I fill out Form DHCS5104?
A: Form DHCS5104 requires information about the healthcare facility, fire safety measures, and contact information. Follow the instructions provided on the form.

Q: Is there a fee for submitting Form DHCS5104?
A: There may be a fee associated with submitting Form DHCS5104. Contact DHCS for more information.

Q: What happens after I submit Form DHCS5104?
A: After submitting Form DHCS5104, DHCS will review the information provided and determine if the healthcare facility meets fire safety requirements for outpatient services.

Q: How long does it take to process Form DHCS5104?
A: The processing time for Form DHCS5104 can vary. Contact DHCS for an estimated processing time.

Q: What if my facility does not meet fire safety requirements?
A: If a healthcare facility does not meet fire safety requirements, DHCS may provide recommendations or require the facility to make necessary improvements before granting fire clearance.

Q: Can I appeal if my facility's fire clearance is denied?
A: Yes, you can appeal if your facility's fire clearance is denied. Follow the instructions provided by DHCS for the appeal process.