N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 2
APPLICATION FOR APPROVAL OF GENERAL HOSPITAL PSYCHIATRIC SERVICES
I. Form of Application for
Approval of a General Hospital's Psychiatric Service
1. The name of the hospital is
............
2. The address and
description of the location is ............
............
............
............
3. The owners are (names of individuals,
partnership, membership corporation, or other type of corporation, religious
order, etc.) ............
............
............
............
4. The proposed capacity of the psuchiatric
service is ............
5. The
name, education and experience of the director of this service is ............
............
............
............
............
............
............
............
________
Applicant
________
Title
________
Date
Notes
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