PDF
Word
Form 445104 Attachment A Home Health Agency Administrator Qualification Review Form - Illinois
What Is Form 445104 Attachment A?
This is a legal form that was released by the Illinois Department of Public Health - a government authority operating within Illinois.The document is a supplement to Form 445104, Home Health, Home Services, Home Nursing Agency Renewal/Change of Ownership Licensure Application. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 445104 Attachment A?
A: Form 445104 Attachment A is the Home Health Agency Administrator Qualification Review Form for Illinois.
Q: Who needs to complete Form 445104 Attachment A?
A: Home health agency administrators in Illinois need to complete Form 445104 Attachment A.
Q: What is the purpose of Form 445104 Attachment A?
A: The purpose of Form 445104 Attachment A is to review and verify the qualifications of home health agency administrators in Illinois.
Q: Are there any fees associated with Form 445104 Attachment A?
A: There are no fees associated with Form 445104 Attachment A.
Q: What information is required on Form 445104 Attachment A?
A: Form 445104 Attachment A requires information such as the administrator's name, qualifications, and previous experience.
Form Details:
- The latest edition provided by the Illinois Department of Public Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 445104 Attachment A by clicking the link below or browse more documents and templates provided by the Illinois Department of Public Health.
Download Form 445104 Attachment A Home Health Agency Administrator Qualification Review Form - Illinois
1
2
3
