Request for Membership. All requests for memberships are subject to an application and initiation process.
Request for Membership. Applicant’s execution of this form shall constitute:
Request for Extension Upon request, the Department may extend the time allowed for both a response to the Letter of Concern and a Corrective Action Plan depending upon the nature of the deficiency. The Provider shall request an extension of time in writing from the Department’s designated representative. The written request shall contain a justification and proposed extension period.