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Get the free FQHC/RHC Notice of Change - ncdhhs

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This document is used to notify the Division of Medical Assistance of any changes regarding the Federally Qualified Health Center or Rural Health Center, including changes in provider information,
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How to fill out fqhcrhc notice of change

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How to fill out FQHC/RHC Notice of Change

01
Obtain the FQHC/RHC Notice of Change form from the appropriate regulatory body or website.
02
Fill in the provider's name and address at the top of the form.
03
Indicate the specific changes being reported in the designated section (e.g., change of ownership, address changes, etc.).
04
Provide the effective date of the changes.
05
List any new responsible parties or management personnel, including their contact information.
06
Include any relevant supporting documentation, such as articles of incorporation, by-laws, or other pertinent records.
07
Review the completed form for accuracy and completeness.
08
Submit the form to the appropriate state or federal health agency, following any specific submission guidelines they have.

Who needs FQHC/RHC Notice of Change?

01
FQHCs and RHCs that are undergoing operational changes.
02
Organizations seeking to update their status with health regulatory agencies.
03
Healthcare providers needing to comply with federal and state regulations regarding facility changes.
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FQHC/RHC Notice of Change is a formal notification required for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to report any significant changes in their operations, services, or management to the relevant health authorities.
FQHCs and RHCs that experience significant changes such as modifications in ownership, service location, or operational procedures are required to file the FQHC/RHC Notice of Change with the appropriate regulatory bodies.
To fill out the FQHC/RHC Notice of Change, organizations must complete the designated form, providing accurate and detailed information about the changes being reported. This may include updates on service delivery, staffing, or facility changes, and must be submitted within the required time frame.
The purpose of the FQHC/RHC Notice of Change is to ensure that health centers maintain compliance with regulatory requirements and to keep health authorities informed of any operational changes that could impact service delivery or funding.
The information that must be reported includes the nature of the change, effective date, contact information, and specific details regarding the new operations, such as changes in hours of operation, services provided, or administrative structure.
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