Surgical practices are required to report the following information annually upon registration. This section must be completed in order for a registration renewal to be issued. Number of surgical patients served by payment source: Number of new surgical patients accepted since last …

Submit documentation from the municipality in which the surgical practice is located that indicates that the plans, specifications and/or required documents for the surgical practice were filed with the municipality prior to September 17, 2009. Submit a completed renewal application.

CN-11: Surgical Practice Application for Registration, Renewal, Relocation, Transfer of Ownership (Formerly HFEL-8) (Updated May, 2016)

cn-1 Full Review Certificate of Need Application for Long Term Care Facilities: General Long Term Care Beds; Specialized Long Term Care Beds (Last Updated January 31st, 2024)

reported on First Report of Injury, or on a previous Form C-11 or EC-11, is changed. Change in employment status includes return to work, discontinuance of work, increase or decrease of regular hours of work and increase or reduction of wages.

CN-9 AUG 17 Page 2 of 2 Pages. SECTION II – RESPONSE (Continued) If the health care professional no longer is employed by, and/or no longer holds privileges at, the responding health care facility, state the reason for the separation of the health care professional from employment and/or the cessation of the health care professional’s

Certifcate of Need forms: CN1-12, letter of intent, periodic progress report, request for changes ... (CN) Forms. CN-1: Certificate of Need Application Word document | PDF format. CN-2: Architectural Section Project Summary ... CN-11: Financial Analysis for Individual Service

Form CN-11 (OAR 333-580-0100(6)) - 1 - Title: Certificate of Need Financial Analysis for Individual Services (word) Author: DHS-OIS-NDS Description: none Last modified by: DHS Created Date: 12/13/2006 7:40:00 PM Company: State of Oregon Other titles:

Form CN-11 (OAR 333-580-0100(6)) - 2 - 2 Identify categories of indirect expenses which may include, but are not limited to: Operational and Maintenance of Plant; Housekeeping; Billing; Insurance. 3 Identify employee type as: Technicians; Nursing; Physicians (staff); Administrative; Other. HISTORICAL CURRENT PROJECTED