ASSISTED LIVING APPLICATION FOR LICENSURE - DHMH - dhmh maryland 2026

1. Click ‘Get Form’ to open the ASSISTED LIVING APPLICATION FOR LICENSURE in our editor.
2. Begin by filling out the 'General Information' section. Indicate whether this is an initial application, renewal, or change of ownership. Provide your legal agency name, trading name (DBA), email address, and contact numbers.
3. Next, specify the number of residents currently served and the number of beds requested. Confirm if all areas of the facility are fully constructed and provide details if not.
4. Complete the 'Ownership' section by selecting your business type and providing necessary details about partners or corporate officers.
5. In the 'Background' section, answer questions regarding any past licenses or criminal history as required.
6. If applicable, provide workers’ compensation insurance information in the designated section.
7. Finally, review your entries for accuracy before signing the affidavit at the end of the form. Ensure all applicants sign where necessary.

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