Adult Day health Care Facilities Application – 498kb

  1. Most Recent State Facility Evaluation Report and any plan of correction resulting from Deficiency Citations.
  2. Copy of your Facility Current License
  3. Copy of Current Valued Loss History for all available years up to maximum of 5 years.
  4. Copy of your any Marketing Brochure
  5. Copy of your Current Policy Declaration Page from your professional liability insurance

Please feel free to call our office at 818-341-2107 with any questions you may have or if you simply needs assistance in completing the application we are here to help you.