Disciplinary Documents Request

Instructions for completing the Request for Disciplinary Documents:

Please complete the attached form in its entirety.

1. Person Requesting Documents:

• Complete your name, address, title & business name (if applicable), telephone/fax number.

1. Documents Requested:

• Complete the name and license number of the respiratory care practitioner, date of action, and check the appropriate box for documents being requested. This information is available on the Stat Report.

1. Reason for Request: (optional)

• Give a brief description of why documents are being requested.

1. Print Request
   
   
2. Sign and date request.
   
   
3. Mail to the Respiratory Care Board's mailing address listed on the top of the request form or fax to (916) 323-9999, Attention: Jennifer Malone. Click below for request form.