Form 445104 Attachment B Home Health Agency - Agency Supervisor Qualification Review Form - Illinois

What Is Form 445104 Attachment B?

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 B?A: Form 445104 Attachment B is the Home Health Agency - Agency Supervisor Qualification Review Form.

Q: What is the purpose of Form 445104 Attachment B?A: The purpose of Form 445104 Attachment B is to review and assess the qualifications of the Agency Supervisor for a Home Health Agency in Illinois.

Q: Who needs to fill out Form 445104 Attachment B?A: The Home Health Agency in Illinois needs to fill out Form 445104 Attachment B to review the qualifications of their Agency Supervisor.

Q: What information is required in Form 445104 Attachment B?A: Form 445104 Attachment B requires information about the Agency Supervisor's education, work experience, training, and licensing.

Q: Is Form 445104 Attachment B specific to Illinois?A: Yes, Form 445104 Attachment B is specific to the state of Illinois and is used for Home Health Agencies in that state.

Q: Can other states use Form 445104 Attachment B?A: No, Form 445104 Attachment B is specifically designed for Home Health Agencies in Illinois and may not be applicable in other states.