Get Hs 200 Form

Filling out the Hs 200 Form is a crucial step in the licensure and certification process for healthcare facilities in California. This guide provides detailed instructions on how to complete the form online, ensuring you can navigate each section with ease.

Follow the steps to successfully complete the Hs 200 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section A, Application Information. Choose the type of application you are submitting by checking the appropriate box.
3. Enter the amount of fee enclosed, if applicable, and indicate the type of change you are applying for.
4. Identify the type of facility you are applying for by checking the appropriate box in the respective section.
5. In Section B, Licensee Information, provide the full name of the licensee and federal employer’s tax ID number.
6. Input the licensee address, and provide contact information including telephone number and email address.
7. In Section C, Facility, Agency or Clinic Information, detail the management agreement if applicable.
8. Complete Section D, Property Information, where you describe your control of the property.
9. Fill out Section E as necessary and ensure compliance with all local ordinances and responsibilities outlined in Section F.
10. Once all sections are completed, save your changes, and prepare to download, print, or share the Hs 200 Form.

Complete your Hs 200 Form online to ensure smooth facilitation of your licensing application.