Get the free NC DHSR AHCLCS: Statement of Deficiencies

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North Carolina Department of Health and Human Services Division of Health Service Regulation Pat McCrory Governor Richard O. Braver Secretary HHS Mark Payne Assistant Secretary for Audit and Health

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How to fill out nc dhsr ahclcs statement

01

Obtain the NC DHSR AHCLCS statement form.

02

Fill in your personal information accurately, including your full name, address, phone number, and email.

03

Provide information about the facility or program being evaluated, including the name, address, and license number.

04

Include details about the services provided at the facility or program.

05

Fill out the rest of the form, following any additional instructions provided.

06

Review the completed form for accuracy and completeness before submitting it.

Who needs nc dhsr ahclcs statement?

01

Any individual or organization operating a healthcare facility or program in North Carolina that is regulated by the Division of Health Service Regulation (DHSR) may need to fill out the NC DHSR AHCLCS statement.

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What is nc dhsr ahclcs statement?

The NC DHSR AHCLCS statement is a form that facilities providing Home and Community-Based Services are required to file annually.

Who is required to file nc dhsr ahclcs statement?

Facilities providing Home and Community-Based Services are required to file the NC DHSR AHCLCS statement.

How to fill out nc dhsr ahclcs statement?

The NC DHSR AHCLCS statement can be filled out online or submitted through a paper form provided by the Department of Health and Human Services.

What is the purpose of nc dhsr ahclcs statement?

The purpose of the NC DHSR AHCLCS statement is to report important information about the services provided by facilities offering Home and Community-Based Services.

What information must be reported on nc dhsr ahclcs statement?

Facilities must report information such as the types of services offered, number of clients served, and any incidents that may have occurred during the reporting period.

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