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DOH Form 661-042 Nursing Home Administrator Expired License Activation Application - Washington
What Is DOH Form 661-042?
This is a legal form that was released by the Washington State Department of Health - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DOH Form 661-042?
A: DOH Form 661-042 is the Nursing Home Administrator Expired License Activation Application.
Q: Who needs to fill out DOH Form 661-042?
A: Nursing Home Administrators with expired licenses in Washington State need to fill out this form.
Q: What is the purpose of DOH Form 661-042?
A: The purpose of DOH Form 661-042 is to activate an expired Nursing Home Administrator license in Washington.
Q: What information do I need to provide on DOH Form 661-042?
A: You will need to provide personal and contact information, as well as information about your previous license and employment history.
Form Details:
- Released on September 1, 2021;
- The latest edition provided by the Washington State Department of 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 printable version of DOH Form 661-042 by clicking the link below or browse more documents and templates provided by the Washington State Department of Health.
Download DOH Form 661-042 Nursing Home Administrator Expired License Activation Application - Washington
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