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Office of Mental Health

OMH Field Offices | Patient Safety Standards Guidelines | BHSA Council

Prior Approval Review
Sample Letter of Intent – EZ PAR or Comprehensive PAR Projects Involving an Existing Licensed Program

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Letter of Intent

Local Government Unit
Office of Mental Health Field Office
Agency name
Agency address

For EZ PAR or Comprehensive Prior Approval Review (PAR) projects involving an existing licensed program, provide operating certificate number, program name:

Cert #:

Name of Program:

Proposed Action: Identify type of project

Narrative: Please provide a brief description of proposed action, identifying the county/borough involved and include anticipated effective date.

Circle type of application to be submitted: EZ PAR / Comprehensive PAR

Chief Executive Officer (CEO)/Executive Director:

Contact Person: name & title

Telephone #:

Email address:

Comments or questions about the information on this page can be directed to the Bureau of Inspection and Certification.