DSHS Form 06-176 Alf Change in Licensed Resident Bed Capacity or Use of Rooms - Washington

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DSHS Form 06-176 Alf Change in Licensed Resident Bed Capacity or Use of Rooms - Washington

What Is DSHS Form 06-176?

This is a legal form that was released by the Washington State Department of Social and Health Services - 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 DSHS Form 06-176?A: DSHS Form 06-176 is a form used in the state of Washington for reporting a change in licensed resident bed capacity or use of rooms at an Assisted Living Facility.

Q: Who needs to complete DSHS Form 06-176?A: The form needs to be completed by the licensee or person in charge of an Assisted Living Facility in Washington.

Q: When is DSHS Form 06-176 required?A: The form is required to be completed and submitted to the Department of Social and Health Services (DSHS) within 30 days of any changes in licensed resident bed capacity or use of rooms at the facility.

Q: What information is needed to complete DSHS Form 06-176?A: The form requires information such as the name and address of the facility, the current and proposed number of licensed resident beds, the types of rooms being used, and the reason for the change.

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Form Details:

  • Released on July 1, 2021;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • 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 DSHS Form 06-176 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

Download DSHS Form 06-176 Alf Change in Licensed Resident Bed Capacity or Use of Rooms - Washington

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