Section 74661 - Application for License(a) Any person, firm, partnership, association, corporation, receiver, political subdivision of the State or other governmental agency desiring to obtain a license shall file with the Department an application. Applicants shall use the Department's forms: Application for Facility License HS 200 (March, 1996), Disclosure of Ownership HS 215 (March, 1996), and Administrative Organization/Organizational Structure HS 309 (September, 1995). These forms and instructions are herein incorporated by reference. The application shall contain the following: (1) Name and address of applicant. (A) If an individual, verification that the applicant has attained the age of 18 years.(B) For all incorporated applicants, the date and state of incorporation, corporation number and, if a foreign corporation, evidence of authority to do business in the State of California.(2) The type of services for which approval is requested.(3) The location of the home health agency and branch offices and basis upon which the applicant exercises control and possession thereof.(4) The name of the administrator in charge of the home health agency.(5) The name and principal business address and the percentage of ownership interest of all officers, directors, stockholders owning 5 percent or more of stock, members, partners and all other persons having authority or responsibility for the operation of the agency and shall provide evidence that all such persons are of reputable and responsible character.(6) Proof of sufficient financial responsibility as may be necessary to operate the agency.(7) A copy of the current organizational chart.Cal. Code Regs. Tit. 22, § 74661
1. Amendment of section and NOTE filed 10-8-97; operative 10-8-97 (Register 97, No. 41). Note: Authority cited: Sections 1734 and 100275, Health and Safety Code. Reference: Sections 1728.1 and 1734, Health and Safety Code.
1. Amendment of section and Note filed 10-8-97; operative 10-8-97 (Register 97, No. 41).