State of Ohio Hea 1901 Form

Name: Ohio Hospital Registration Form - Fill Out and Sign Printable PDF Template | signNow
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Rating: 4.7 (126 reviews)

Use a ohio hospital registration template to make your document workflow more streamlined.

Designation Pediatric Trauma Level Designation ODH 2004 HEA 1901 Not Applicable SCHEDULE D. Name of Chief Executive Officer Title 5. Name of person s Responsible for submitting form Telephone Number Accreditation/certification status Check One JCAHO AOA EXPIRATION DATE or MEDICARE CERTIFICATION only if not accredited above ODH 2004 HEA 1901 Satellite Units Indicate name address county and zip code of each satellite unit owned and operated by the hospital i.e. Emergency Medical Center Surgery...

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