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APPLICATION FOR LICENSE TO OPERATE ACCOUNTING/DEPARTMENT USE ONLY A BASIC CARE FACILITY Check Number License Number NORTH DAKOTA DEPARTMENT OF HEALTH DIVISION OF HEALTH FACILITIES SON 16855 (R1019)Amounted
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To fill out a basic care facility, follow these steps:
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Start by gathering all the necessary information about the care facility, such as its name, address, and contact details.
03
Provide a brief description of the care facility, including the types of services offered and any special features or accommodations available.
04
Include information about the staff members and their qualifications, as well as any certifications or accreditations the facility has.
05
Clearly outline the admission process and any requirements or criteria that need to be met for an individual to be eligible for care at the facility.
06
Specify the costs and payment options for the care facility, including any insurance coverage or financial assistance programs available.
07
Include any additional information or policies that may be important for potential residents or their families to know, such as visiting hours or rules and regulations.
08
Review the completed form to ensure accuracy and completeness before submitting it to the appropriate authorities or agencies.
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Keep a copy of the filled-out form for your records.

Who needs a basic care facility?

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A basic care facility is typically needed by individuals who require assistance with their daily activities due to age, illness, or disability.
02
This may include older adults who are no longer able to live independently and need help with tasks such as bathing, dressing, medication management, and meals.
03
Individuals with chronic illnesses or disabilities that limit their mobility or ability to care for themselves may also benefit from a basic care facility.
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Additionally, individuals who have recently undergone medical procedures or hospitalizations and need temporary assistance during their recovery may seek out a basic care facility.
05
Family members or caregivers who are unable to provide the necessary level of care at home may also rely on a basic care facility to ensure the safety and well-being of their loved ones.
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A basic care facility is a healthcare center that provides essential care services to individuals who are unable to care for themselves.
Basic care facilities are typically required to be filed by the facility administrators or owners.
Filling out a basic care facility typically involves providing information about the facility's services, staff, and compliance with regulations.
The purpose of a basic care facility is to ensure that individuals in need of care receive necessary services in a safe and regulated environment.
Information such as services offered, number of residents or patients, staff qualifications, and compliance with regulations must be reported on a basic care facility.
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