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State of California—Health and Human Services Agency

California Department of Public Health

MARK B HORTON, MD, MSPH Director

EDMUND G. BROWN JR. Governor

TO:

Home Health Agencies

SUBJECT:

Fingerprint Clearance Requirements for Owners, Administrators, and Administrator’s Designee

January 6, 2011

AFL 11-06

The purpose of this All Facilities Letter is to serve as a reminder of the criminal record clearance requirements for home health agencies licensed by the department. Pursuant to Health and Safety Code Section 1728.1(a)(2)(A) a criminal record clearance is required for the following individuals:

  • The owner or owners of a home health agency if the owners are individuals;

  • If the owner of a home health agency is a corporation, partnership or association, any person having a ten (10) percent or greater interest in that corporation, partnership or association and;

  • The administrator and administrator’s designee of a home health agency.

The individuals identified above are required to submit a Request for Live Scan Service: BCII 8016 form. For your convenience, a link to the BCII 8016 and a sample form is provided. The "sample form" provides instructions to assist you in correctly entering the required information. Once the form is completed, the Request for a Live Scan Service: BCII 8016 form should be taken to a live scan vendor.

  • 1Sample Form (Completed) Request for Live Scan Service: BCII 8016(PDF)

  • 2Request for Live Scan Service: BCII 8016 (PDF)

Please note the live scan vendor will complete the Transaction Section (gray area) of the Live Scan Service: BCII 8016 form.

1 2

http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/bcii8016Samplefiu-Sept2010.pdf http://ag.ca.gov/fingerprints/forms/BCII_8016.pdf

Licensing and Certification Program, MS 0512, P.O. Box 997377, Sacramento, CA 95899-7377 (Internet Address: www.cdph.ca.gov)

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