The California Hs 402 form is a surety bond verification document required by the California Department of Public Health. This form ensures that licensed health facilities, which handle significant amounts of patient money, are bonded to protect patients' funds. For those needing to complete this form, please click the button below to get started.
The California HS 402 form is a crucial document for health facilities operating within the state, particularly those that manage patient funds. This form serves as a verification of a surety bond, which is mandated by California law for licensed health facilities that handle significant amounts of money—specifically, over $25 per patient or more than $500 in total for all patients within a month. The bond acts as a financial safety net, ensuring that these facilities handle patient funds with integrity and accountability. Completing the HS 402 form involves the bonding agency, which must provide an original copy of the bond along with the completed form. In the event that the bond is canceled, the bonding agency is required to notify the California Department of Public Health's Licensing and Certification Program promptly. The form outlines the obligations of the health facility and the bonding agency, emphasizing the importance of safeguarding patient funds. Should any patient suffer damages due to mishandling of their money, they have the right to take legal action against the bond, reinforcing the need for compliance with the law. This bond is not only a legal requirement but also a vital component in maintaining trust and safety in the healthcare system.
State of California—Health and Human Services Agency
California Department of Public Health
Licensing and Certification Program
SURETY BOND VERIFICATION
Reply to: California Department of Public Health
Centralized Applications Unit
P.O. Box 997377, MS 3402
Sacramento, CA 95899-7377
California Health and Safety Code, Section 1318, Chapter 2, Division 2, requires that licensed health facilities that handle money in excess of $25 per patient or over $500 for all patients in any month, be bonded for not less than $1,000. This is to serve as a guarantee for the faithful and honest handling of the money of such patients.
INSTRUCTIONS: This form is to be completed by the bonding agency. In addition, attach an original copy of the bond. In the event of cancellation of the bond, please send notice to the above licensing office.
BE IT KNOWN THAT:
Facility name
Facility address
City
County
ZIP code
State of California, as Principal, and
Bonding agency
Agency address
State of
, as Surety, are held and firmly bound unto the STATE OF CALIFORNIA in the full and just sum of
DOLLARS ($
), for the payment of which the said Principal and said Surety
bind themselves, their respective heirs, successors, and assigns, jointly and severally, firmly by these presents.
The CONDITION of this obligation is such that
WHEREAS, the Principal has applied for or has been issued a license by the California Department of Public Health to maintain or conduct a health facility pursuant to Chapter 2, Division 2, of the Health and Safety Code of the State of California; and
WHEREAS, by the terms of Section 1318 of said code, the Principal is required to file with the California Department of Public Health, Licensing and Certification, the bond running to the State of California.
NOW, THEREFORE, if the above bounden Principal shall faithfully and honestly handle money of patients in the care of said Principal, then this obligation shall be null and void; otherwise to remain in full force and effect.
Every patient injured as a result of any improper or unlawful handling of the money of a patient of a health facility may bring an action in a proper court on the bond required to be posted by the licensee pursuant to this section for the amount of damage he/she suffered as a result thereof to the extent covered by the bond.
This bond may be canceled by the Surety in accordance with the provisions of Section 996.310 et seq. of the Code of Civil
Procedure. This bond is effective
and continuous.
Date
IN WITNESS WHEREOF, we have subscribed our names and impressed our seal this
,
.
Day
Month
Year
Bonding agent name (please print)
Bonding agent signature
BONDING AGENCY SEAL
HS 402 (2/08)
After gathering the necessary information, you are ready to fill out the California HS 402 form. Follow the steps below to ensure that you complete the form accurately. Make sure to have an original copy of the bond ready to attach as instructed.
Once you have completed the form, attach the original bond. Be sure to send the completed form and bond to the California Department of Public Health Licensing and Certification Program at the address provided. Ensure that you keep a copy for your records.
What is the purpose of the California HS 402 form?
The California HS 402 form is used to verify surety bonds for licensed health facilities. It ensures that these facilities, which handle significant amounts of patient money, are bonded for at least $1,000. This bond acts as a guarantee for the proper handling of patient funds.
Who needs to complete the HS 402 form?
What is the minimum bond amount required?
The minimum bond amount required is $1,000. This ensures that there are sufficient funds available to cover any damages resulting from improper handling of patient money.
What happens if the bond is canceled?
If the bond is canceled, the bonding agency must notify the California Department of Public Health Licensing and Certification Program. This notification is crucial to maintain compliance with state regulations.
What are the consequences of failing to handle patient money properly?
If a health facility improperly handles patient money, any affected patient can bring a legal action against the bond. This allows patients to seek damages for any financial harm suffered due to the facility's actions.
How long is the bond effective?
The bond is effective and continuous, meaning it remains in effect until it is canceled according to the provisions of the law. This provides ongoing protection for patients and ensures accountability.
What information is required on the HS 402 form?
The HS 402 form requires information such as the facility name, address, and the bonding agency's details. Additionally, the bond amount must be specified, along with signatures from the bonding agent and the facility principal.
Where should the completed HS 402 form be sent?
The completed HS 402 form, along with the original copy of the bond, should be sent to the California Department of Public Health Licensing and Certification Program at the address provided in the instructions.
Is the HS 402 form subject to any specific regulations?
Yes, the HS 402 form is governed by the California Health and Safety Code, specifically Section 1318. Compliance with these regulations is essential for maintaining a valid license for health facilities.
Filling out the California HS 402 form can be a straightforward process, but there are common mistakes that individuals often make. These errors can lead to delays or complications in the bonding process. Understanding these pitfalls can help ensure that the form is completed correctly.
One frequent mistake is failing to provide the correct facility information. It is essential to accurately enter the facility name, address, city, county, and ZIP code. Any discrepancies in this information can cause confusion and may delay the processing of the bond.
Another common error involves the amount of the bond. The form requires a specific dollar amount to be filled in, and it must align with the requirements set forth by California law. Omitting this amount or entering it incorrectly can render the bond invalid.
Some individuals neglect to attach the original copy of the bond to the form. This step is crucial, as the bond must be submitted alongside the HS 402 form for it to be considered complete. Without this attachment, the application may be rejected.
Additionally, there can be issues with the signature of the bonding agent. It is vital that the bonding agent signs the form where indicated. A missing or illegible signature can lead to questions about the validity of the bond.
Many applicants also overlook the importance of the date. The form must be dated correctly to reflect when it was completed. An incorrect date can lead to complications, especially if the bond is questioned later.
In some cases, individuals may not fully understand the conditions of the bond. It is important to read and comprehend the obligations outlined in the form. Misinterpretation of these conditions can lead to non-compliance, which may have legal repercussions.
Another mistake is failing to notify the licensing office in the event of cancellation of the bond. This notice is a requirement, and neglecting to inform the appropriate office can result in penalties for the facility.
Lastly, some people do not keep a copy of the submitted form for their records. Retaining a copy is important for future reference and can be useful if any issues arise regarding the bond or the facility’s compliance.
By being aware of these common mistakes, individuals can approach the completion of the California HS 402 form with greater confidence and accuracy. Taking the time to ensure all information is correct can save time and prevent complications in the bonding process.
The California HS 402 form is an important document for health facilities that handle patient funds. However, it is often accompanied by other forms and documents that help ensure compliance with state regulations. Below are some of the key documents that are commonly used alongside the HS 402 form.
These documents work together to protect both the health facilities and the patients they serve. Understanding each of these forms can help ensure that all regulatory requirements are met and that patient funds are handled responsibly.
The California HS 402 form is related to several other documents that serve similar purposes in the realm of health facility licensing and financial accountability. Here are six documents that share similarities with the HS 402 form:
When filling out the California HS 402 form, it's essential to follow specific guidelines to ensure accuracy and compliance. Here are some important do's and don'ts to keep in mind:
There are several misconceptions about the California HS 402 form that can lead to confusion. Here are four common ones:
This is not true. Any licensed health facility that handles more than $25 per patient or over $500 in total for all patients in a month must complete this form, regardless of its size.
In fact, the bond requirement applies to all licensed health facilities under California Health and Safety Code Section 1318. This includes hospitals, nursing homes, and other care facilities.
The bond can be canceled by the bonding agency, but they must follow the proper procedures outlined in the Code of Civil Procedure. Notice of cancellation must be sent to the licensing office.
Patients do have the right to bring an action in court against the bond if they suffer damages due to improper handling of their money. This is an important protection for patients.
When dealing with the California HS 402 form, there are several important points to keep in mind. This form is essential for health facilities that manage patient funds. Here are key takeaways to consider:
Understanding these key points can help ensure compliance with California regulations and protect both facilities and patients alike.