Get Renewal Application Packet - Dhmh - Maryland.gov - Dhmh Md

This guide provides detailed instructions for completing the Renewal Application Packet for Comprehensive Care and Extended Care Facilities managed by the Maryland Department of Health and Mental Hygiene. By following these steps, users can ensure a smooth and efficient application process.

Follow the steps to fill out the renewal application packet online.

1. Use the ‘Get Form’ button to obtain the Renewal Application Packet and open it in your preferred editor.
2. Begin by filling out the Applicant Information section. This includes entering the email, fax number, name of the facility, location, and telephone number. Ensure all fields are accurately completed.
3. Indicate the type of business organization by checking the appropriate box, whether it is an individual, partnership, or corporation. Then, specify the type of control, such as proprietary or government unit.
4. If applicable, fill out the Leasing Arrangement section by providing the names and addresses of the lessee and lessor, along with the expiration date of the lease.
5. Complete the Long Term Care Facility Type section by selecting the type of care facility being applied for, and attaching the room and bed breakdown if necessary.
6. Enter the license fee based on the number of beds in your facility and prepare a check made payable to the Maryland Department of Health and Mental Hygiene.
7. Obtain the required signatures from the applicants, ensuring that the document is duly notarized.
8. Complete sections B through I, providing all necessary agreements, certifications, and disclosures regarding the facility, physicians, nursing agreements, legal actions, and compliance.
9. Ensure all required documents are attached, including the Certificate of Compliance if applicable, Workers' Compensation information, and any necessary affidavits.
10. Review the completed application packet for accuracy and completeness, then save any changes. Users can also download, print, or share the document as needed.

Submit your completed renewal application online to ensure timely processing!