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Licensing and Certification

Hemodialysis Technician Program Applicants

The following items must be submitted for application consideration:

  • Hemodialysis Technician/Patient Care Technician Training Program Application (CDPH 391) (PDF) (Revised 03/19)
    • CHP program outline.
    • List all current instructors on CDPH 391 even if previously approved.
      • Resume(s) for each new RN instructor along with a copy of his or her RN license.
        Note: The resume must verify 2 years of RN experience and one of which must be as a Hemodialysis RN.
    • Copy of the CHT Clinical skill checklist (Initial applications only or if there is a change).
    • Copy of the CHT competency test (Initial applications only or if there is a change)
    • Contact Information Form (CDPH 193) (PDF) (Revised 12/19)
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