Dhsr 4204-2025

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4 out of 5

47 votes

The document is a licensure application form from the North Carolina Department of Health and Human Services for home care, nursing pool, and hospice services. It outlines the requirements for applicants, including legal identity, agency information, services offered, accreditation details, ownership disclosure, and certification of accuracy. The form emphasizes that separate applications are needed for different sites and legal entities. It also includes sections for service categories provided by in-house staff or through contracts.

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