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Sections 144G 45 or 144G 81 Waiver Request Assisted living licensure form 2026
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How to use or fill out Sections 144G 45 or 144G 81 Waiver Request Assisted living licensure form with our platform
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- Click ‘Get Form’ to open the Sections 144G 45 or 144G 81 Waiver Request form in the editor.
- Begin by selecting your request type: either 'New waiver request' or 'Waiver renewal'. This helps categorize your submission.
- Fill out the Licensee Information section, providing details such as the facility license number, HFID number, facility name, and contact information.
- In the Requestor’s Contact Information section, enter the legal name and contact details of the individual MDH can reach for questions regarding this waiver request.
- Detail your Waiver Details by specifying the requirement for which you are requesting a variance, along with reasons and alternative measures if granted.
- Complete the Official Verification section by checking each statement to confirm your understanding and agreement. Sign and date where indicated.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2021 | 4.8 Satisfied (44 Votes) |
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