Application for Home Care Organization Licensure 2025

1. Click ‘Get Form’ to open the Application for Home Care Organization Licensure in our editor.
2. Begin with Section 1, where you will enter your home care organization information, including the name, contact details, and mailing address. Ensure all fields are filled accurately to avoid delays.
3. Proceed to Section 2 to provide ownership details. Indicate whether the organization is for-profit or not-for-profit and attach any required documents if you are an initial applicant.
4. In Section 3, fill out the operator's information if it differs from the owner. Include their contact details and address.
5. Section 4 requires you to specify your hours of operation. Clearly list opening and closing times along with the days of operation.
6. Continue through Sections 5 to 10 by providing geographic service areas, drop site information (if applicable), administrative personnel details, services offered, and client rights policy.
7. For initial applicants, complete Sections 11 through 16 by attaching necessary documents such as proof of financial ability and insurance coverage.
8. Finally, in Section 17, ensure that you include the appropriate fee for licensure and sign the affidavit before submitting your application.

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