Get Mn Application For Licensure Temporary Comprehensive Home Care 2022-2025

Filling out the MN Application for Licensure Temporary Comprehensive Home Care online is an essential step for individuals and organizations wishing to operate as a temporary licensed home care provider in Minnesota. This guide will provide clear, step-by-step instructions to help you navigate through the application successfully.

Follow the steps to complete your application efficiently.

1. Use the ‘Get Form’ button to access the application form and open it in your preferred editing platform.
2. Begin by entering your applicant information. Complete the section labeled 'Assumed Name' or 'Doing Business As' name, followed by your physical address, county, telephone, fax, and mailing address. Ensure all entries are accurate to avoid delays in processing.
3. Designate an agent who will be responsible for receiving important notices and ensure to provide their name, title, contact information, and if applicable, indicate if they have the same contact details as you.
4. Detail any other licenses you may hold in Minnesota or other states. Complete the questions regarding past revocations or denials of licenses and provide necessary attachments if applicable.
5. List any additional office locations that will be associated with your home care services and specify the counties you will serve.
6. In the 'Home Care Services' section, indicate the types of services you plan to provide by entering the corresponding numbers. This includes comprehensive and basic home care services.
7. Provide the details of any registered nurse or other licensed health professional who will be associated with your services, including their contact information.
8. Complete the ownership information section. List the full legal name of the entity applying and provide pertinent tax identification numbers.
9. Fill out the managerial officials' section with their relevant details and confirm their connection to home care clients.
10. Specify if there is a management company involved in the provision of services and provide their details accordingly.
11. Ensure compliance with background study requirements and submit any necessary documentation associated with workers' compensation insurance.
12. Attach all required documentation, check the application checklist, and confirm all signatures and initials are present before final submission.
13. Mail the completed application along with the necessary fees and attachments to the address provided in the application.

Complete your application for licensure online today to start your home care service!