AGING AND DISABILITY SERVICES ADMINISTRATION
March 15, 2002
AASA: AFH #2002-009
REQUEST FOR 15-DAY REVISIT
Dear Adult Family Home Provider:
The department has developed the enclosed form in an effort to assist you in requesting an on-site review for correction of a deficiency resulting in stop placement. The use of the form is voluntary.
To assist in facilitating your request, effective April 2, 2002, the department will enclose this request form with the letter of notice for the enforcement action. This form, when completed, may be faxed to your field office.
If you have any questions in regard to this form, please contact your Field
Manager.
Sincerely,
Patricia K. Lashway, Director
Residential Care Services
