1. a) Documentation that the applicant meets the definition of primary provider. (See Section 710.20, Definitions.)
2. b) Documentation of the applicant's actual or proposed affiliation with a Regional Alzheimer's Disease Assistance Center.

3. c) A description of the proposed service area shall include at a minimum all of the following items:

   1. 1) Specific geographic areas to be covered with specific services.
   2. 2) Target populations to be served, including age groups by sex, race and population size.
4. d) A description of the specific services to be provided that comply with the criteria in Sections 710.160 to 710.180.
5. e) A description of the professional medical staff, support staff and equipment to be provided.
6. f) Written plans for transportation services for outreach that assure access to services for persons with ADRD and families.
7. g) Copies of written plans for complying with minimum standards for referral, treatment and support services under Sections 710.160 to 710.180.
8. h) Financial eligibility criteria for receiving services.
9. i) Utilization reports on facilities and services available from primary providers to ADRD patients and families within the service area.
10. j) Copies of reports on research and treatment.

To be considered for designation as a primary provider, an applicant must provide the following documentation and information:

(Source: Amended at 25 Ill. Reg. 11159, effective September 1, 2001)