Application for home care licensure
[PDF File]In-Home Services License Application Packet
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DOH 505-053 September 2019 Page 1 of 3 When your application for an In-Home Services Agency License is received by the Department of Health (DOH), it will be reviewed and you will be notified in writing of any
[PDF File]LICENSURE APPLICATION for In-Home Care Provider …
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LICENSURE APPLICATION . for . In-Home Care Provider . REGULATION 61-122 . Return all documentation to: Email Address (preferred method): IHCP@dhec.sc.gov OR . Mailing Address: Bureau of Health Facilities Licensing . 2600 Bull Street . Columbia, SC 29201 . For additional questions, contact us at: 803-545-4370.
[PDF File]Application for Home Care Licensure – General Instructions
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May-2018 Basic Home Care License Page 1 Application for Home Care Licensure – General Instructions General Instructions This application form should be used by individuals and organizations seeking initial approval to operate as a licensed home care provider and by licensed providers seeking approval for a proposed change of
[PDF File]INITIAL APPLICATION FOR LICENSE TO OPERATE A HOME …
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The Application for License to Operate a Home Health Agency (SF 4008) must be completed in its entirety and submitted to the Department, along with supporting documents and/or information and the required $250.00 non-refundable license application fee .
[PDF File]Home Care Agency Licensing Application
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LICENSE FEE After the Home Care Application is processed and prior to issuance of a Home Care Agency license, the agency/organization shall pay Hawaii Department of Health an initial licensure fee of $1,200 paid by corporate check, bank or other financial institution check, or money order made payable to the “State of Hawaii, Office of Health ...
[PDF File]Application for Home Care Licensure: Schedule 1
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Bureau of Home Care Licensure and Certification Application for Home Care Licensure: Schedule 1 Attended Institution Address From To Degree Date Received 3. Professional Licenses/Certifications Held If Not Applicable, Please Check Here: ☐ Type of Professional License/ Institution Granting License/Certification Certification License/Certification
[PDF File]Application for Home Care Licensure - General Instructions ...
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According to Article 36 of the Public Health Law, a home care services agency subject to licensure is an organization engaged in arranging and/or providing, either directly or through contract arrangement, nursing, home health aide or personal care services.
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