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Department of health and mental hygiene code of maryland regulations 100705 form 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the official name of your agency in the designated field. Ensure accuracy as this will be used for all official correspondence.
- Fill in the trading name (dba) if applicable, followed by the agency address and mailing address if different. Include your business phone number and fax number.
- Indicate the days and hours of operation, along with an emergency contact number. This information is crucial for compliance checks.
- Complete the section regarding home care services by checking the appropriate level of care provided. Be specific about complex care types offered by your agency.
- Attach a non-refundable application fee of $500.00, made payable to the Maryland Department of Health and Mental Hygiene, as instructed.
- Review all sections thoroughly before submitting to ensure completeness, as incomplete applications will be returned.
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