IC 16-25-3-3: Application

Sec. 3. (a) An applicant shall submit an application for a hospice license or for approval of a hospice program on a form prescribed by the state department.

(b) The applicant shall attach to the application evidence of the applicant's ability to comply with the minimum standards established for licensure under this article.

(c) The application must contain the following information:

(1) The applicant's name.

(2) The type of hospice program the applicant will own or operate.

(3) The location of the hospice program owned or operated by the applicant.

(4) The name of the individual or individuals responsible for the day to day operation of the hospice program owned or operated by the applicant.