Health Facilities Administration Applications & Forms
- Adult Family Care
- Change in Ownership
- For a Change in Ownership, certified health facilities also need to complete the CMS 855 A form. Completed CMS 855A forms need to be sent to your fiscal intermediary for processing.
- Individual Home Care Service Provider
- Laboratories & Collection Stations
- Initial and Renewal Application HFA (under currently adopted rules)
- Adverse Event Report
- NH DHHS Emergency Preparedness Template
- Resident Assessment Tool
- Waiver Request
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