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