Follow the steps to successfully complete your Nursing Home Application online.

1. Click the ‘Get Form’ button to obtain the form and access it in your preferred editor.
2. Begin with Part I, where you must fill out the applicant information including the full name, business address, and type of entity (individual, partnership, corporation, etc.). Be sure to also include the number of employees and the years of operation.
3. Proceed to the operations section where you will answer questions regarding certifications for Medicare and Medicaid, licensing, and facility classifications.
4. In the services section, indicate the services your facility provides, such as subacute care and rehabilitation, along with the percentage of patients receiving each service.
5. Complete the claims/history section to provide any previous claims or issues that may affect your application.
6. If you are seeking general liability coverage, fill out the premises info and procedures sections concerning safety equipment and evacuation procedures.
7. Lastly, review the application thoroughly for accuracy. Once completed, the application must be signed and dated by the owner, partner, or officer before submission.
8. You can save your changes, download, print, or share the completed form as needed.

Take the next step and complete your forms online now.