Lic 809 2026

1. Click ‘Get Form’ to open the lic 809 in the editor.
2. Begin by entering the facility name, director, and facility number in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the address and telephone number of the facility. This helps maintain clear communication with licensing authorities.
4. Select the type of visit from options such as Office, Prelicensing, Management Annual, or Follow-up. Mark any applicable deficiencies on the left side of the form.
5. Document any civil penalties if applicable. Indicate whether a penalty was assessed or cleared and provide comments regarding deficiencies.
6. Complete the Plan of Corrections (POCs) section by detailing specific actions to address cited deficiencies. Be thorough to avoid misunderstandings.
7. Finally, ensure all signatures are obtained where required, including that of the licensing evaluator and facility representative before saving your document.

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