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Brian P. B Kemp, GovernorCaylee Toggle, Commissioner2 Peachtree Street, NW Atlanta, GA 303033159 4046564507 www.dch.georgia.govMEMORANDUM Date:July 16, 2021To:Chief Executive Officer Chief Financial
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Step 1: Go to the website dch.georgia.gov/contact-us/contact-us.
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The Georgia Department of Community Health.
Individuals and organizations as specified by the Georgia Department of Community Health.
The form can be filled out online or submitted by mail as per the instructions provided by the Georgia Department of Community Health.
The purpose is to collect specific information for regulatory and reporting purposes.
Details of income, expenses, and other relevant financial information.
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