Get Mn Application For Licensure Temporary Comprehensive Home Care 2021

Filling out the MN Application For Licensure Temporary Comprehensive Home Care online is a critical step for individuals and organizations aiming to operate as a licensed comprehensive home care provider in Minnesota. This guide will provide detailed, step-by-step instructions to help you navigate the application process with ease.

Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to access the MN Application For Licensure Temporary Comprehensive Home Care and open it for completion.
2. Begin with the applicant information section. Fill in your assumed name, physical address, city, state, ZIP code, county, telephone, fax, and mailing address. Ensure that all information is accurate and up-to-date.
3. For the agent section, designate one person as your authorized agent who will receive all notices. Provide their name, title, telephone, and email address.
4. Complete the 'Description of Other Licenses' field, indicating any other licenses or enrollments you hold. If applicable, attach the required addendum for any previously revoked licenses.
5. List additional office locations if you have more than one. Provide the addresses and telephone numbers as required.
6. Identify the counties where you intend to provide services, ensuring you only list those counties where services will be offered.
7. Fill in the home care services section by entering '1', '2', or '3' as instructed based on how services will be provided.
8. Provide the information for the registered nurse or other licensed health professional, including their name, license number, and contact details.
9. Complete the ownership information section, clearly stating the legal name and the tax ID numbers. Specify any parent organization if relevant.
10. Fill in the ownership interests and managerial officials sections with the relevant details of all owners, including percentage of ownership and if they will have direct contact with home care clients.
11. Confirm compliance with workers' compensation insurance requirements by checking the appropriate box and providing documentation as necessary.
12. Review all completed sections to ensure accuracy and completeness. Remember to include your application checklist with all required attachments.
13. Finally, save the changes you made to the form. You can download, print, or share your completed application as needed.

Get started on your application today and ensure a smooth process for your home care licensing.