Get Ahca Form 3140 2004 Dev 2008

Filling out the Ahca Form 3140 2004 Dev 2008 is essential for tissue banks to report their annual tissue procurement, distribution, revenues, and expenses. This guide provides clear, step-by-step instructions to help you complete the form online, ensuring compliance and accuracy.

Follow the steps to fill out the Ahca Form 3140 2004 Dev 2008

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In the top section of Part I, enter your d/b/a agency name, the certificate number issued by the Agency for Health Care Administration, and the calendar year the report covers.
3. For Part I, Donor Information, provide the total number of tissue donors, and categorize them by race: White, Black, Hispanic, Asian/Pacific Islander, American Indian/Alaskan Native, and Other.
4. Next, indicate the number of donors based on their cause of death, including categories such as Motor Vehicle, Gunshot/Stab, Cardiovascular, and others provided in the form.
5. List the total number of donors originating from various sources, including Hospitals, Medical Examiners, and Funeral Homes. Specify the number referred from each medical examiner district.
6. In Part II, Tissue Distribution Summary, indicate the total number of tissue grafts retrieved and processed during the reporting period, and categorize their distribution as transplanted, used in research, discarded, or remaining in inventory.
7. Move to Part III and record the beginning and ending dates of your fiscal year alongside the total gross revenues from procurement activities in Florida.
8. For Part IV, Expenses, provide the relevant dollar amounts for variable and fixed expenses, direct expenses, allocated overhead, and tissue inventory. Ensure all calculations are accurate.
9. Finally, review all entries for accuracy, and save your changes. You can then download, print, or share the completed form.

Complete the Ahca Form 3140 2004 Dev 2008 online today to ensure accurate reporting and compliance.