Get Ok Odh 924 2018-2025

Filling out the OK ODH 924 is a crucial step in applying for a license to operate a hospice agency in Oklahoma. This guide will provide you with clear and structured instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the OK ODH 924 form online.

1. Click 'Get Form' button to access the OK ODH 924 and open it in the online editor.
2. Select the application type and corresponding license fee. Ensure that you choose the correct option based on whether you are applying for an initial license, renewal, change of ownership, or change of information.
3. Prepare the required attachments for your application type. These may include proof of financial solvency, administrator and supervising RN credential verification, and other specified documents.
4. Complete the ENTITY section, providing the organization’s name and DBA (if applicable). Attach proof that these names are registered with the Oklahoma Secretary of State.
5. Fill in the ENTITY BUSINESS FORMAT/TYPE section. Specify your business structure, such as a sole proprietorship or corporation.
6. Enter the PHYSICAL ADDRESS of your hospice agency, ensuring it is not a residential location, followed by the mailing address for correspondence.
7. Provide the information for the ADMINISTRATOR, including their printed name, email address, and required license verification.
8. List your AGENCY OFFICE HOURS. Specify the operational hours for each day of the week.
9. Indicate the GEOGRAPHIC AREA you wish to serve by selecting appropriate counties from the provided list.
10. If applicable, fill out the ACCREDITATION section to denote any deemed status with recognized accrediting organizations, along with expiration dates.
11. Complete the required information for BOARD OF DIRECTORS, detailing names and addresses of board members.
12. List OWNERSHIP OF AGENCY details, including pertinent information on owners and affiliated persons as needed.
13. If relocating, answer the RELLOCATION questions thoroughly in an attachment. This includes reasons for the move and impact on service.
14. Finalize by reviewing the CONVICTIONS section, ensuring you disclose any relevant offenses. Remember to provide attachments as necessary.
15. Once all sections are completed, users can save changes, download, print, or share the form to submit the application.

Begin filling out the OK ODH 924 online today to take the first step in licensing your hospice agency.