Home Care Initial Survey Checklist - NC DHHS

home care Initial Survey Checklist LICENSE APPLICATION PROCESS: An applicant must be able to complete all necessary requirements within one year (12 months) from receipt of the Initial application and fee date to obtain a license. After Initial licensure , the agency must have the license renewed every year. Agency Name: City: Date: Supporting Documentation (submit the documents listed below) Comments Proof previously owned/operated a HC agency {.0903 (a)} (if applicable). Certificate of DHSR approved HC training course {.0903(a)} (if applicable). Agency Organization Chart {.1001 (8)}. Proof of Premise for Operation {.0903 (b)} (commercial lease if applicable). Articles of Incorporation or Limited Liability Corporation (if applicable).

Home Care Initial Survey Checklist Rev 9/21 gdh LICENSE APPLICATION PROCESS: An applicant must be able to complete all necessary requirements within one year (12 months) from receipt of the initial application and fee date to obtain a license. After initial licensure, the agency must have the license renewed every year.

Tags:

  Applications, Checklist, Care, Licensure, Home, Home care

Information

Related search queries