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.
Q: What is form DOH 260-004?
A: DOH Form 260-004 is the Nursing Home Full Facility Closure Bed Banking Notice - Washington.
Q: What is the purpose of form DOH 260-004?
A: The purpose of form DOH 260-004 is to notify the Washington State Department of Health (DOH) about the full facility closure of a nursing home and its intention to preserve and bank licensed beds for future use.
Q: Who needs to fill out form DOH 260-004?
A: Nursing homes that are planning to close fully and want to preserve and bank licensed beds for future use in Washington State need to fill out form DOH 260-004.
Q: What information should be included in form DOH 260-004?
A: Form DOH 260-004 should include the nursing home's name, address, license number, the number of licensed beds to be banked, the date of closure, and the future use plan for the banked beds.
Q: Is there a deadline for submitting form DOH 260-004?
A: Yes, nursing homes must submit form DOH 260-004 at least 120 days prior to the planned closure date of the facility.
Q: What happens after form DOH 260-004 is submitted?
A: After form DOH 260-004 is submitted, the Washington State Department of Health will review the application and may request additional information if needed.
Q: Can a nursing home reopen after submitting form DOH 260-004?
A: Yes, a nursing home can reopen after submitting form DOH 260-004 if it meets certain conditions, such as obtaining a new license and complying with all applicable regulations.
Q: Who should I contact if I have questions about form DOH 260-004?
A: If you have questions about form DOH 260-004, you can contact the DOH Licensing and Certification Services office for assistance.
Form Details:
Download a printable version of DOH Form 260-004 by clicking the link below or browse more documents and templates provided by the Washington State Department of Health.