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HOSPITAL/HEALTH SYSTEM ATTESTATION OF COMPLIANCE WITH FACILITY FEE PATIENT NOTIFICATION AND TRANSPARENCY REQUIREMENTS OF C.G.S. 19a508c AFFIDAVIT CALENDAR YEAR 2022 Indicate, with a checkmark, that
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01
Download the CY-2022 Facility Fee Notice Affidavit PDF from the ct.gov website.
02
Open the PDF in a compatible PDF viewer or editor.
03
Fill in the required information in the designated fields such as facility name, address, and contact information.
04
Provide details about the services offered and any required certifications or licenses.
05
Sign and date the affidavit at the bottom of the form.
06
Review the completed form for accuracy and ensure no fields are left blank.
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Save the filled-out document and print a copy if required.
08
Submit the affidavit as per the instructions provided, either online or by mail.

Who needs cy-2022-facilityfeenotice-affidavitpdf - ctgov?

01
Healthcare facilities operating in Connecticut that are subject to facility fees.
02
Organizations seeking to establish or maintain compliance with state regulations.
03
Any entity that requires acknowledgment of fees associated with facility services.
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The cy-2022-facilityfeenotice-affidavitpdf is a form used by healthcare facilities in Connecticut to officially report facility fees.
Healthcare facilities operating in Connecticut that charge facility fees are required to file the cy-2022-facilityfeenotice-affidavitpdf.
To fill out the cy-2022-facilityfeenotice-affidavitpdf, obtain the form from ct.gov, complete the relevant fields with accurate information about facility fees, and submit it as per the instructions provided.
The purpose of the cy-2022-facilityfeenotice-affidavitpdf is to ensure transparency and compliance regarding facility fees charged by healthcare facilities.
The cy-2022-facilityfeenotice-affidavitpdf must report details such as the facility name, address, type of services provided, and the specific facility fees charged.
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2022 2023 19a 508c attestation rightmost 19a508c ohsnotificationandfilings 486i 110b attests checkmark subdivisions subsections transparency compliant prominently acknowledges applicable subscribed subsection gov attest pursuant uploading notification pre

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