Department of health and mental hygiene code of maryland regulations 100705 form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the official name of your agency in the designated field. Ensure accuracy as this will be used for all official correspondence.
3. 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.
4. Indicate the days and hours of operation, along with an emergency contact number. This information is crucial for compliance checks.
5. 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.
6. Attach a non-refundable application fee of $500.00, made payable to the Maryland Department of Health and Mental Hygiene, as instructed.
7. Review all sections thoroughly before submitting to ensure completeness, as incomplete applications will be returned.

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