New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Appendices
Appendix 2

Current through Register Vol. 46, No. 12, March 20, 2024

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

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