NC DHHS DHSR/HCPEC 4502 2015 free printable template
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2709 Mail Service Center
Raleigh, NC 276992709
Division of Health Service
RegulationHealth Care Personnel Education and
Credentialing SectionPhone: 9198553970
Fax: 9197339764
N.C. Department of Health
and
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How to fill out NC DHHS DHSRHCPEC 4502
How to fill out NC DHHS DHSR/HCPEC 4502
01
Begin by downloading the NC DHHS DHSR/HCPEC 4502 form from the official website.
02
Fill in the basic information section, including the name and address of the facility.
03
Specify the type of facility (e.g., adult care, child care) in the designated field.
04
Provide information about the administrator or facility director, including their contact information.
05
Complete the sections related to staff and staffing patterns, ensuring to include qualifications.
06
Include details regarding the services offered by the facility.
07
Fill in the policies related to resident care and safety protocols.
08
Review the completed form for accuracy and completeness.
09
Sign and date the form as required.
10
Submit the form to the appropriate NC DHHS office by mail or electronically as per guidelines.
Who needs NC DHHS DHSR/HCPEC 4502?
01
Any adult care or child care facility in North Carolina that is seeking licensure.
02
Individuals or organizations planning to open a new health care facility.
03
Current facilities undergoing renewal of their licensing.
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What is NC DHHS DHSR/HCPEC 4502?
NC DHHS DHSR/HCPEC 4502 is a form used in North Carolina for reporting certain healthcare-related information to the Division of Health Service Regulation.
Who is required to file NC DHHS DHSR/HCPEC 4502?
Facilities and providers regulated by the North Carolina Division of Health Service Regulation, including healthcare providers and institutions, are required to file NC DHHS DHSR/HCPEC 4502.
How to fill out NC DHHS DHSR/HCPEC 4502?
To fill out the NC DHHS DHSR/HCPEC 4502, ensure that you read the instructions carefully, provide all requested information accurately, and submit the form by the specified deadline.
What is the purpose of NC DHHS DHSR/HCPEC 4502?
The purpose of NC DHHS DHSR/HCPEC 4502 is to collect data and information required for compliance with health services regulations and to ensure quality care in healthcare facilities.
What information must be reported on NC DHHS DHSR/HCPEC 4502?
The information that must be reported on NC DHHS DHSR/HCPEC 4502 typically includes facility details, services provided, staffing information, and any incidents or quality assurance data as mandated by the regulations.
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