Get Ok Odh 924 2008
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How to fill out the OK ODH 924 online
Filling out the OK ODH 924 application for a hospice license is a crucial step for healthcare providers in Oklahoma. This guide will provide you with a comprehensive, step-by-step approach to completing this form online efficiently and accurately.
Follow the steps to successfully complete your application.
- Press the ‘Get Form’ button to download the OK ODH 924 form and open it in your preferred online editor.
- Begin by carefully entering the operating entity's name in the designated section. This should be the name of the organization responsible for running the hospice.
- Input the necessary contact information, including the telephone number and fax number, ensuring that all details are accurate.
- In the next section, provide the ‘doing business as’ (D.B.A.) name if the hospice operates under a different name. Include the location and mailing addresses as required.
- Fill in the name of the hospice administrator, patient care coordinator, and medical director in the respective fields.
- Indicate the fiscal year ending date appropriately, using the dropdown options or manual entry, based on the system's requirements.
- List all stockholders with at least a 5% ownership interest in the hospice, including their mailing addresses and percentage of ownership.
- If applicable, indicate any changes to the plan of delivery and provide a narrative update explaining these changes.
- Select the type of control applicable to your hospice from the provided options, ensuring to check all that may apply.
- Attach requisite documents for the board of directors and contracted services, labeling each attachment as per instructions.
- Indicate accreditation status if any, and provide the expiration date, ensuring to complete all fields accurately.
- Fill in the geographic area served by your hospice by selecting the relevant counties listed.
- If relocating, respond to the additional questions on a separate sheet as specified, ensuring to reference each question appropriately.
- Finally, sign and date the application, ensuring all signatures are from the appropriate persons who are knowledgeable about the information provided.
- Once completed, save your changes, then download a copy if necessary. You may also choose to print or share the form as required.
Complete your OK ODH 924 application online today for a streamlined process.
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