Texas hospital license change of ownership

To ensure you submit the correct amount, please do ONE of the following if applicable :. Food manufacturers, warehouse operators, food wholesalers, and food wholesale registrants may use the Regulatory Services Online Licensing System to apply for initial licenses and to renew existing licenses.

We are currently unable to process minor amendment changes online, such as name and address changes. Please see the Multiple Products applications on the Drug Manufacturers and Distributors website to apply for a multiple products license for two or more of the following. Skip to content 3. Scroll over the image for more information.

This includes all of the individuals identified in Item 12b i , as well as the administrator, alternate administrator and chief financial officer. This affidavit attests that you have read, understand and are able to meet the requirements listed in Title 40 Texas Administrative Code Chapter 97 and Health and Safety Code Chapter Complete the affidavit.

Click on the word affidavit above for a. This affidavit attests that your agency as the provider of services states and declares that it has the financial resources to meet its proposed budget and to provide the services required during the term of the license. Click on the word affidavit above for a copy of this affidavit. The following documents must be submitted with the application packet:.

Additional information concerning these documents maybe found on pages of Form and by clicking here. The following additional documents must be submitted for a CHOW:.

Additional information concerning these documents maybe found on page 18 of Form and by clicking here. Additional information concerning these documents maybe found on page 18 of Form The following documents must be submitted:. In addition, one of the following must be submitted: as filed with the Texas Secretary of State.

Additional information concerning these documents maybe found on page 19 of Form and by clicking here. DIrections: Answer each question. At the end of the quiz please clck on the answer button to see your score. You have completed this presentation. Take time to review the application and to ensure that all the required documentation is in the application packet before mailing. Who Should Fill Out Form Those persons providing Home Health, Hospice or Personal Assistance Services PAS for pay or other considerations in a client's residence, an independent living environment or another appropriate location should submit this application.

This presention: is designed to provide only general information about the licensing application requirements. It remains the full responsibility of each applicant to complete the application in its entirety with accurate information; follows Form which is divided into sections that require the applicant to fill out specific information; and includes information from Title 40, Part 1, Chapter 97 Subchapter B to ensure the participant has all the required information to complete Form The particpant should scroll over the images or underlined words for more information.

National Provider Identification Number. Presurvey Conference CBT To avoid delays in the application process, the applicant should ensure that the appropriate individuals have completed the presurvey computer-based training CBT before submission of Form Scroll over the image for suggestions on taking CBT's. Form Sections The application is divided up into 14 sections. Don't use pencil or white out correctional fluid. Do submit all required supporting documentation, including the required fee. Don't submit documents without being notarized.

Don't forget to complete all applicable sections of the application. Types of Application. An application for a license when there is a CHOW is an application for an initial license. An agency's place of business must be located in and have an address in Texas. An applicant must be at least 18 years of age. Before issuing a license, DADS considers the background including criminal history and qualifications of: the applicant; a controlling person of the applicant; a person with a disclosable interest; an affiliate of the applicant; the administrator; the alternate administrator; and the CFO.

Initial licensure applicants must meet certain criteria. Application procedures for certification When an agency requests the initial license application including certification, the applicant completes and submits a CMSA enrollment application and all supporting documentation to its fee-for-service contractor.

DADS sends out a reminder of expiration. Renewal licensure process Renewal applications must be submitted before the expiration date. An agency may request a renewal application before or after the expiration of the license.

Factors affecting a relocation An agency must not transfer a license from one location to another without prior notice to DADS. DADS will use the postmark to determine whether or not to assess a late fee. Agency Relocation physical address. Page 1 Sections 1, 3, 4, 5a and 5b and Page Mailing Address if different from physical address.

Agency Contact Information telephone number or Operating Hours. Page 1 Sections 1, 3, 5 and 6 and Page Page 1 Sections 1, 3, 4 and 5 and Page Name of Owner Legal Entity name change only, not change of ownership.

Agency Organization management — administrator or chief financial officer. Agency Organization management — alternate administrator. Page 1 Sections 1, 3, 4, and 5 , Page 2 Section 9 and Page Other fees are listed below. Section 3 Business Information Fill out the correct information for each box on the application. Section 4 and 5 Name and Address Fill in the blanks on the application. Ensure Item 4 indicates the name the agency that your agency will be DBA. Section 6 Management Information Fill out all the required information.

Section 7 Accreditation Status DADS recognizes three accrediting organization and the links to their websites are listed below. Section 8 Contracts with State Agencies Follow the directions on the application for each blank. Section 9 Categories of Service Each of these categories are defined and reviewed during the presurvey conference CBT.

This section is divided up into regions. Please check the boxes for each of counties you serve. If an agency is Medicare certified, all of its counties must be contiguous. Section 12 Ownership and Control Interest Disclosure In section 12, check the type of organizational structure of your agency. Check one of the boxes on the application for Profit or Nonprofit. This includes: All stockholders individual persons and any business entities owning a percentage of the agency.

All directors, partners, members, officers, executives and trustees. Section 12 Ownership and Control Interest Disclosure. Therefore, if a pharmacy changes ownership, the new owner must obtain a new pharmacy license.

Rules require a location change be submitted 30 days prior to such change and a name change, within 10 days of such change. If the pharmacy is needing to correct its address due to changes made by USPS, City, County, or , contact the licensing division at Change of Pharmacist-in-Charge PDF : A pharmacy shall report in writing to the board not later than the 10th day after the date of change of the person designated as the pharmacist-in-charge of the pharmacy.