Change Notification Form (Ownership Management Contact)

The Change Notification Form is a new, essential compliance document designed for assisted living facilities and similar organizations to promptly report changes in ownership, management personnel, or facility contact information to regulatory agencies. This form ensures your facility remains in compliance with state requirements and maintains up-to-date records with oversight authorities.

Key Features:

• Clearly organized sections to capture all required facility information, including facility name and license number
• Easy-to-use checkboxes to indicate the type of change: ownership, executive director, alternate executive director, or contact information updates
• Dedicated fields for detailed documentation of new ownership, management personnel, and updated contact details
• Certification and submission section for authorized personnel to sign and date, verifying the accuracy and completeness of the information provided

This Change Notification Form streamlines regulatory communication, reduces administrative errors, and helps your facility demonstrate accountability and transparency during organizational changes. It is an ideal solution for assisted living communities and healthcare providers seeking a professional, compliant method for updating agency records.