TOTAL ANTICIPATED FUNDS / recordation Limited liability company / Company Subchapter S Corporation / Partnership Limited liability Company / Subchapter C Corporation / Be Attached Partnership Limited liability company / Name / Subchapter S / Non-Profit Corporation / Individual (sole proprietor) Partnership partnership / /
unprofitable services / residents requiring services / health planning district using mapping software / transportation / patient care services / health services / short-stay services / energy sources / public transportation / required additional utility services / authorized services / health care services / transportation arrangements / example dental services / local energy utility / energy / public wastewater treatment/disposal services / resident services / food service / uncommon services / public transportation system / therapeutic services / utility services / Travel time / project site / adequate solid waste removal services / adequate energy services / or increase access to needed services / corporate operator / medical service travel patterns / similar services / existing medical service travel patterns / /
Organization
State Corporation Commission / Certification Division / Division of COPN / regional health planning agency / Medicare / DIVISION OF CERTIFICATE OF PUBLIC NEED Application for a Certificate of Public Need / NH AL / U.S. Federal Emergency Management Agency / DEPARTMENT OF HEALTH / Virginia Department of Medical Assistance Services / DEPARTMENT OF HEALTH office of Licensure / /
Person
AL NH AL NH AL / Job Shift / Water Supply / /
Position
director of nursing / architect / medical director / facility administrator / etc. / director of the facility / Director of nursing ____ / licensed nursing home administrator / consultant / underwriter / proprietor / officer / present medical director / State Fire Marshal / managing partner / facility administrator / managing partner / Official / personal physician / commissioner / writer / EXECUTIVE / Administrator / State Health Commissioner / chief administrative officer / /
ProvinceOrState
Virginia / Nursing Home Residents Prior to Admission County / Virginia Planning District / OPSA / /
VIRGINIA DEPARTMENT OF HEALTH, DIVISION OF CERTIFICATE OF PUBLIC NEED Application for a Certificate of Public Need – (name of project): ______________________________________ COPN Request No. VA - ________ Date prepar