Get Organizational Application Checklist Of Materials To Submit ... - Lifewayscmh

This guide provides step-by-step instructions for completing the ORGANIZATIONAL APPLICATION Checklist Of Materials To Submit for Lifewayscmh. By following these instructions, users can efficiently gather and submit the necessary materials for their application.

Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to access the ORGANIZATIONAL APPLICATION Checklist, which will open in your document editor.
2. Carefully read the instructions provided at the beginning of the application. Make sure to complete the application in full, attaching all requested documentation as needed.
3. In the 'Organizational Information' section, fill out the name of the organization, the chief administrator's name, and the organization's contact information, including address, telephone numbers, and email address.
4. Indicate the type of organization by selecting the appropriate option from the provided choices, such as For-Profit Corporation or Non-Profit Corporation.
5. In the 'Billing Information' section, enter your organization's billing number(s) as applicable, including Tax ID, National Provider Identifier, and any other relevant billing numbers.
6. For the section regarding malpractice insurance, provide details of all malpractice insurance carriers for the past five years, attaching a copy of the insurance certificate that indicates limits and expiration dates.
7. List three professional references who can speak to your organization’s clinical abilities and ethical character. Ensure that their knowledge of your services is relevant.
8. Complete the 'Disciplinary Actions' section by responding to each question honestly and attaching a separate sheet if any responses are 'Yes'.
9. Provide all necessary documentation as requested throughout the form, such as copies of agency licensure, accreditation certificates, and malpractice insurance.
10. Once all fields are completed, review your application for accuracy, save your changes, and utilize the options available to download, print, or share the completed form as required.

Complete your organizational application online today for a seamless submission process.