Get the free NC DHSR ACLS: Statement of Deficiency - info.ncdhhs.gov

PRINTED: 11/06/2020 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:PINE FOREST REST HOME (X4) ID

How to fill out nc dhsr acls statement

How to fill out nc dhsr acls statement

1. To fill out the NC DHSR ACLS statement, follow these steps:
2. Begin by printing or typing your name and contact information at the top of the form.
3. Read the statement carefully and make sure you understand the information provided.
4. Fill out the required fields, such as your license number, date, and signature.
5. Provide accurate and detailed information in the designated sections of the form.
6. If applicable, attach any supporting documents that may be required.
7. Double-check all the information you have provided for accuracy.
8. Review the form one last time before submitting it.
9. Submit the completed form through the appropriate channel specified by the NC DHSR.

Who needs nc dhsr acls statement?

1. The NC DHSR ACLS (Adult Care Licensure Section) statement is needed by individuals or organizations involved in adult care services in the state of North Carolina.
2. This includes but may not be limited to:
3. - Licensed adult care homes
4. - Adult care unit managers
5. - Adult care home administrators
6. - Adult care home operators
7. - Adult care home supervisors
8. - Adult care act of 1985 providers
9. It is important to consult the official guidelines or contact the NC DHSR directly to determine if you are required to submit this statement.

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What is nc dhsr acls statement?

The nc dhsr acls statement is a form required by the North Carolina Department of Health Service Regulation (DHSR) for reporting information related to Adult Care Licensure and Certification Section (ACLS).

Who is required to file nc dhsr acls statement?

Any facility or organization in North Carolina that provides adult care services and is licensed or certified by the DHSR is required to file the nc dhsr acls statement.

How to fill out nc dhsr acls statement?

The nc dhsr acls statement can be filled out online on the DHSR website by providing the requested information related to adult care services provided by the facility or organization.

What is the purpose of nc dhsr acls statement?

The purpose of the nc dhsr acls statement is to ensure that facilities and organizations providing adult care services in North Carolina are in compliance with the regulations set forth by the DHSR.

What information must be reported on nc dhsr acls statement?

The nc dhsr acls statement requires information such as the name and address of the facility, the services provided, the number of residents or clients served, and any actions taken to improve the quality of care.