Get Dqa Form F 00191

Filling out the Dqa Form F 00191 is an essential step for certified outpatient clinics seeking to request a branch office. This guide provides clear instructions to help users complete the form accurately and efficiently in an online format.

Follow the steps to complete the Dqa Form F 00191 online.

1. Click the ‘Get Form’ button to access the Dqa Form F 00191 and open it in your online document editor.
2. Fill in your certification number at the specified section. This is essential for identifying your main clinic.
3. Enter the email address of the contact person for your clinic. Ensure that this email is active for future communication.
4. Indicate the intensity and type of clinic, selecting options such as mental health, AODA, or both.
5. List the days and hours of operation for psychotherapy or substance abuse counseling at the branch office.
6. Answer whether consumer records are kept at the branch office and describe how the records are stored if applicable.
7. Finally, attest to the accuracy of the information provided by signing the form as the clinic administrator, and include your printed name and the date signed.
8. Once all sections are complete, save the changes and choose to download, print, or share the form as needed.

Complete your Dqa Form F 00191 online today to ensure your clinic can effectively serve its clients through a branch office!