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The California HS 402 form is a crucial document for licensed health facilities that manage patient funds. Under California Health and Safety Code, Section 1318, any facility handling more than $25 per patient or over $500 in total monthly must secure a surety bond of at least $1,000. This bond serves as a financial guarantee, ensuring the responsible management of patient funds. The form must be filled out by the bonding agency and submitted alongside an original copy of the bond. In case the bond is canceled, the bonding agency is required to notify the California Department of Public Health's Licensing and Certification Program. This document binds the facility and the bonding agency to the State of California, affirming their commitment to handle patient money with honesty and integrity. If a patient suffers financial harm due to mismanagement of their funds, they have the right to pursue legal action against the bond for damages. The HS 402 form is not just a regulatory requirement; it is a safeguard for patients, ensuring that their financial interests are protected while receiving care.