Form HS 215A. Applicant Individual Information
Form HS 215A serves as a crucial component of the application process for state healthcare facility licensing and federal certification. It is mandatory for individuals holding more than five percent ownership or key positions within these establishments. The form facilitates the collection of comprehensive information regarding the applicant's personal and professional background, affiliations, criminal history, employment records, and engagements with healthcare entities.
Usage Examples:
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Licensing Application for New Healthcare Facility:
- Scenario: A group of investors plans to establish a new medical center.
- Relevance: Each investor with a significant ownership stake must complete Form HS 215A to provide their relevant details.
- Outcome: Regulatory authorities review the submitted forms to ensure the individuals meet the criteria for ownership.
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Certification Renewal for Established Clinic:
- Scenario: An existing specialized clinic seeks to renew its federal certification.
- Relevance: The clinic's key personnel, such as the Medical Director and Chief Operating Officer, must update their Form HS 215A.
- Outcome: Authorities verify the provided information before granting certification renewal, ensuring the clinic's leadership is reputable.
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Key Staff Change in Healthcare Agency:
- Scenario: A high-level executive at a healthcare agency, overseeing multiple facilities, is replaced.
- Relevance: The incoming executive and the outgoing executive's replacement both need to complete Form HS 215A.
- Outcome: The agency submits the updated forms, allowing regulators to assess the new executive's fitness for the role.
Purpose:
Form HS 215A plays a vital role in promoting transparency and accountability within healthcare organizations. By gathering comprehensive information about individuals with ownership stakes or key positions, regulatory bodies can make well-informed decisions about licensing and certification. This scrutiny ensures that individuals involved in healthcare facilities are of high integrity, ultimately contributing to the delivery of quality healthcare services to the public.