REGULATIONS
Vol. 41 Iss. 11 - January 13, 2025

TITLE 12. HEALTH
DEPARTMENT OF HEALTH
Chapter 381
Forms

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Forms

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 201 North Ninth Street, Fourth Floor, Richmond, Virginia 23219.

Title of Regulation: 12VAC5-381. Regulations for the Licensure of Home Care Organizations.

Agency Contact: Val Hornsby, Policy Analyst, Office of Licensure and Certification, Virginia Department of Health, 9960 Mayland Drive, Henrico, VA 23233, telephone (804) 875-1089, or email val.hornsby@vdh.virginia.gov

FORMS (12VAC5-381)

Application for Home Care Organization Licensure (rev. 4/2021)

Renewal Addendum for Licenses Expiring July 31, 2021 (eff. 4/2021)

VA.R. Doc. No. R25-8181; Filed December 17, 2024