Form
Document used for application, enrollment, registration or eligibility determination purposes.
Effective Date	Title - Owner - Description
01/06/2010	Adverse Event Reporting Form - Health Facilities Administration - This form must be submitted for adverse events in hospitals and ambulatory surgical centers.
07/10/2009	Request For Waiver Form For Health Care Facilities - Office of Operations Support, Health Facilities Administration-Licensing - This form can be used as a template guideline when requesting waivers for any licensed facility.
07/01/2009	Application for Licensing a New Health Care Facility - Bureau of Health Facilities Administration - Required to be completed and submitted to the Bureau of Health Facilities Administration for licensing a residential care or health care facility.
07/01/2009	Application for Change in Ownership of a Health Care Facility - Bureau of Health Facilities Administration - Required to be completed and submitted to the Bureau of Health Facilities Administration for licensing a change in ownership of a residential care or health facility.
07/01/2009	Licensing Application Laboratories and Collecting Stations - Office of Operations Support Bureau of Health Facilities Administration - Licensing Application for Laboratories and Collecting Stations and related documents.
07/01/2009	Licensing Application for Adult Family Care - Office of Operations Support, Health Facilities Administration-Licensing - Licensing Application for Adult Family Care.
07/01/2009	Licensing Application for Supported Residential Care and Residential Care Facilities - Bureau of Health Facilities Administration - Send complete application package and fees to NH DHHS, Office of Program Support Bureau of Health Facilities Administration,  129 Pleasant Street, Concord, NH  03301-3857
05/06/2009	Resident Assessment Tool - Office of Program Support Bureau of Health Facilities Administration - Tool to assess the needs of residents in Assisted Living Facilities.