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Get the free DMA-9052-ia.pdf. Adult Care Home Notice of TransferDischarge - info dhhs state nc

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Print Form ADULT CARE HOME NOTICE OF TRANSFER/DISCHARGE 1) DATE OF NOTICE: Resident Name: Facility: Administrator: Address: Phone: 2) DATE OF TRANSFER/DISCHARGE: 3) REASON FOR THIS NOTICE: Under North
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How to fill out DMA-9052-IAPDF Adult Care Home:

01
Start by downloading the DMA-9052-IAPDF form from the official website of the regulatory agency responsible for adult care homes.
02
Carefully read the instructions provided with the form to understand the purpose and requirements.
03
Begin filling out the form by entering the name and contact details of the adult care home, including the facility's address, phone number, and email.
04
Next, provide information about the primary owner or operator of the adult care home, including their name, address, phone number, and email.
05
If applicable, indicate any additional owners or operators and provide their contact details as well.
06
Fill in the section that requires details about the adult care home's license, including the license number, issue date, and expiration date.
07
Provide information about the type of adult care services offered by the facility, such as assisted living, memory care, or nursing care.
08
Indicate the number of licensed beds available in the adult care home.
09
Fill in the section related to the staff qualifications, including the number of direct care staff and any specific certifications required by the licensing agency.
10
Provide information about the adult care home's policies and procedures, including admission criteria, safety protocols, and emergency plans.
11
Finally, carefully review all the information provided before submitting the completed DMA-9052-IAPDF form.

Who needs DMA-9052-IAPDF Adult Care Home:

01
Individuals or organizations planning to open or operate an adult care home.
02
Existing adult care home owners or operators renewing their licenses.
03
Regulatory agencies responsible for overseeing adult care homes, who require the form to gather information and ensure compliance with regulations.
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dma-9052-iapdf adult care home is a form used for reporting information about adult care homes.
Adult care home operators are required to file dma-9052-iapdf.
dma-9052-iapdf adult care home form can be filled out online or submitted in paper format with the required information.
The purpose of dma-9052-iapdf adult care home form is to collect data and ensure compliance with regulations for adult care homes.
Information such as facility details, number of residents, staff information, and compliance with regulations must be reported on dma-9052-iapdf.
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2015 North_Carolina DHHS DMA-9052 ombudsmans 131D Raleigh NC developmentally TTY OMBUDSMAN mandated notifying mediation NOTIFICATION convened waived specified obtaining practitioner physicians sufficiently documented Administrator accommodations

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