PDF
Word
Form 445105 Pregnancy Termination Center (Astc) Licensure Renewal Application - Illinois
What Is Form 445105?
This is a legal form that was released by the Illinois Department of Public Health - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 445105?
A: Form 445105 is the Pregnancy Termination Center (ASTC) Licensure Renewal Application in Illinois.
Q: Who needs to use Form 445105?
A: Pregnancy termination centers in Illinois need to use Form 445105 for licensure renewal.
Q: What is the purpose of Form 445105?
A: The purpose of Form 445105 is to renew the licensure of pregnancy termination centers (ASTCs) in Illinois.
Q: What information is required on Form 445105?
A: Form 445105 requires information such as the name and address of the pregnancy termination center, the qualifications of the medical director, and details about the services provided.
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 445105 by clicking the link below or browse more documents and templates provided by the Illinois Department of Public Health.
Download Form 445105 Pregnancy Termination Center (Astc) Licensure Renewal Application - Illinois
1
2
3
4
5
6
7
