1. (a) Each application for a provisional license for a home health agency, home services agency, home nursing agency, home services placement agency, or home nursing placement agency as provided in Section 4 shall contain the following information:

   1. (1) name, address and location of the agency;
   2. (2) organization and governing structure of agency;
   3. (3) number and qualification of staff;
   4. (4) sources of financing of services and agency;
   5. (5) service area;
   6. (6) patient load;
   7. (7) agency utilization;
   8. (8) service charges;
   9. (9) affiliation agreements with other health care providers; and
   10. (10) such other information as the Department may require.
2. (b) Applications for licenses shall be in accordance with departmental regulations.

(from Ch. 111 1/2, par. 2805)

(Source: P.A. 103-257, eff. 1-1-24.)