Get Dads Provider Letter 11-02: Revised Disclosure Section Of Form 3720-n (nf Application), Form 3720 2020-2025

Filling out the DADS Provider Letter 11-02 is an essential step for facilities submitting Form 3720-N. This guide offers clear and systematic instructions for completing the revised disclosure section online, ensuring all relevant details are accurately provided.

Follow the steps to complete the DADS Provider Letter 11-02 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Carefully review the revised disclosure section's instructions. Ensure that you understand the specific disclosure items detailed in the DADS Provider Letter 11-02. This includes reviewing changes made to item 9 on Form 3720-N.
3. Fill out item 9, providing information based on the five-year disclosure questions E, F, G, H, I, and J. Make sure to include all required data for the five years immediately preceding the date of your application as instructed.
4. If necessary, attach the required supporting documents for the Disclosure of Facility/Agency Association section. Clearly identify the records you are submitting and annotate the relevant application section with ‘see attached document’.
5. Review question E carefully and provide details relevant to civil damages and lawsuits connected to malpractice or other care-related issues.
6. Complete question K ensuring to report only unpaid or outstanding judgments and lawsuits related to slips and falls or other employment-related issues.
7. Double-check all entries for accuracy and completeness after filling out the form. Make revisions if needed.
8. Once you have finalized the form, save your changes. You may wish to download, print, or share the completed form as required.

Start completing your DADS Provider Letter 11-02 online today to ensure timely and accurate submissions.