護士從業員申請信息
護士從業人員 必須通過 PAVE（提供者申請和註冊驗證）提交個人和/或團體申請。 如果您正在提交團體申請，請確保您在 PAVE 中提交至少兩份渲染申請。
授權
在申請加州醫療補助健康保健計劃之前，請先諮詢加州註冊護理委員會，以確保您符合所有許可要求。
所需文件
接下來，收集下面列出的所需文件（視適用），以便在完成 PAVE 申請時將它們上傳到 PAVE。 請確保上傳的文件易於閱讀。
1. 由加州註冊護理委員會認可的國家或州組織頒發的加州註冊護士執照和執業護士證書，並指定專業培訓領域。
二.申請人的駕駛執照或州發出的身份證（在美國 50 或哥倫比亞特區發行）。
三.專業責任保險證書，每宗賠償金額不少於 10 萬元，年度最低總計 30 萬元。 可接受的驗證是保險公司發出的保險證明書或聲明表，其中包含保險公司名稱、受保人名稱、生效日期和保障限制。 注意：加州註冊護士執照和執業護士證書上顯示的提供者名稱也必須顯示在職業責任保險的驗證中。
4. For ‘individual stand alone enrollment’: Federal Employer Identification Number (FEIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please visit the IRS or call them at (800) 829-4933.
5. For ‘individual stand alone enrollment’: Certificate of Commercial Liability Insurance (business, general, or comprehensive liability, or office premises insurance) in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, effective dates, and limits of coverage. Note: The name and business address, including suite number if applicable, of the applicant or provider on the application must exactly match the insured’s name and address on the certificate of insurance or declaration sheet.
6. For ‘individual stand alone enrollment’: Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name and business address of the applicant or provider must match the insured’s name and address on the certificate of insurance.
7. For ‘individual stand alone enrollment’: Signed Lease Agreement, if business premises are not owned by the applicant or provider. Note: The name and business address of the applicant or provider must exactly match the lessee’s name and address on the lease agreement.
8. For ‘individual stand alone enrollment’: Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must exactly match the business name and business address on all local licenses and permits. If a business license/permit is not required, please submit a written statement from your local city/county indicating that your business does not require any license or permit. For further information, please contact your city business license office and/or visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
9. For ‘individual stand alone enrollment’: Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must exactly match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
10. For ‘individual stand alone enrollment’ ：如果您的企業是公司，則可以通過附加國務司長提交的註冊章程副本，以及董事和官員姓名和職稱清單，以及每個公司的所有權和控制權益的百分比，以避免處理延誤。
To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
11. For ‘individual stand alone enrollment’: If your business is a partnership, a fully executed Partnership Agreement. Processing delays may be avoided by indicating whether the entity is a General Partnership or Limited Partnership and also submitting the following:
a) 對於一般合夥人，列出所有合夥人的清單，其中包含每個合夥人的所有權或控制權益百分比；或
b) 對於有限合夥人而言，識別一般合夥人的資料，以及所有合夥人清單，其中包含每個合夥人的所有權或控制權益百分比。
要驗證或更改您的合夥企業的名稱和/或狀態或了解更多信息，請訪問國務卿加州商業門戶網站並單擊“加州商業搜索”鏈接或其他適當的鏈接。
12. For ‘individual stand alone enrollment’: Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.