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Get Odh Form 953-a, Fillable Pdf - State Of Oklahoma Web Site - Ok
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How to use or fill out the ODH Form 953-A, Fillable PDF - State Of Oklahoma Web Site - Ok online
Filling out the ODH Form 953-A is essential for obtaining the necessary license for a nursing or specialized facility in Oklahoma. This guide will provide clear and supportive instructions to help you complete the form accurately and efficiently.
Follow the steps to successfully complete the ODH Form 953-A.
- Click the ‘Get Form’ button to obtain the form and open it in your preferred PDF editor.
- Begin by entering the facility ID number assigned by the Oklahoma State Department of Health.
- Fill out the applicant/licensee name accurately. If this is a renewal application, indicate if there have been any changes in the previous application by selecting 'Yes' or 'No'.
- If the answer to the previous question is 'Yes', attach the ODH Form 958, Notice of Change.
- Confirm if the licensee is the responsible party for employment taxes. Answer 'Yes' or 'No'. If 'No', provide the name, address, and tax identification number of the responsible person or entity.
- Enter the facility name (doing business as) and ensure it matches the Medicare facilities' requirements.
- Fill in the complete location of the facility, including street address, city, county, state, and zip code.
- Provide the contact person's details, including their name, phone number, email address, and mailing address.
- Indicate the administrator's name and select the type of facility license by checking the appropriate box.
- Specify the total number of beds available at the facility.
- Answer whether the facility markets itself as providing care for individuals with Alzheimer's disease or related disorders. If 'Yes', complete and attach ODH Form 613.
- If this is an initial license application, ensure to attach ODH Forms 953-B, 953-C, 953-D, and 953-E as required.
- After completing the application, review all information for accuracy, then save changes, download, print, or share the form as necessary.
Complete your application online today to ensure compliance with licensing requirements.
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