Lic 809 2025

1. Click ‘Get Form’ to open the lic 809 in the editor.
2. Begin by filling in the 'Facility Name', 'Director', and 'Facility Number' fields at the top of the form. Ensure that all information is accurate to avoid any compliance issues.
3. Next, indicate the 'Type of Visit' by selecting from options such as Office, Prelicensing, Annual, or Follow-Up. This helps clarify the purpose of your evaluation.
4. In the 'Deficiency Information' section, document any deficiencies noted during the visit. Use codes provided on the left side to reference specific regulations.
5. Complete the 'Plan of Corrections (POCs)' section by outlining specific actions you will take to address each deficiency. Be detailed to ensure clarity.
6. Finally, have both the Licensing Evaluator and Facility Representative sign and date the form at the bottom before submitting it through our platform for processing.

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