Home care license application
[PDF File]Application for Home Care Licensure - General Instructions ...
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This application form should be used by proposed home care services organizations seeking initial approval as a licensed home care services agency or organizations seeking approval for a proposed change of ownership or operator, an acquisition or a change in control of an existing licensed home
[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 …
[PDF File]LIC279 Application for a Family Child Care Home Licesne
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Application For a Family Child Care Home License? These are instructions for filling out the Application for a Family Child Care Home License (LIC 279). Match the numbered items on this page with the numbered sections on the Application. For your information, details on the Application are public information. 1. TYPE APPLICATION
[PDF File]INSPECTION INFORMATION FOR APPLICANTS SEEKING TO …
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12. Provide a copy of the New Jersey license of the Health Care Practitioner Supervisor, Registered Nurse or Licensed Physician employed by the agency. Payment of the Registration Fee: The fee to register as a health care services firm is $500 for each primary …
[PDF File]LICENSURE APPLICATION for In-Home Care Provider …
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The current licensee is responsible for renewal of the license prior to the expiration date regardless of any changes or pending approvals (i.e., ownership changes or capacity increases/decreases) from the Department that are in progress at the time the license is due …
[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
[PDF File]If you fail to submit all requested information, the ...
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The following series of documents contain the application materials for a Home Care Agency/Home Care Registry. Please note that all questions must be answered, and all requested supporting documentation must be provided. If you fail to submit all requested information, the application materials will …
[PDF File]Application Instructions for A Home Care Organization License
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PAGEM2OF 16 Community Care Licensing Division Home Care Services Bureau Application Booklet for a Home Care Organization License INTRODUCTION These instructions are intended to help you file an application for a Home Care Organization license.
[PDF File]GEORGIA DEPARTMENT OF COMMUNITY HEALTH 2 …
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Georgia state license prior to providing Private Home Care Provider services. Enclosed are the Private Home Care Provider rules and regulations, an application for a Private Home Care Provider license, Criminal Records Check Legislation, House Bill 155 and a list of all the documents required by HFRD in order to consider your application complete.
[PDF File]IN-HOME CARE AGENCY
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Page 1 of 4 Revised: 10/2018 In-Home Care Agency License Application Form Type of Action New Agency*: Parent Subunit (provide name of parent agency and city where located.In addition, attach separate document identifying all subunits associated with the
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