Current through Register No. 45, November 7, 2024
Section Saf-C 5920.02 - Protocol Prerequisite Application Form(a) Each applicant for a protocol prerequisite approval shall complete a protocol prerequisite application which shall be:(b) Each applicant shall provide the following: (1) Applicant information, which shall include: d. City or town of residence;h. Contact telephone number;i. Fax number, if available;l. MRH medical director, or his or her designee; andm. Medical director contact phone number;(2) Type of application requested: (3) The protocol title and number, for which the applicant is applying.(c) The applicant shall submit supporting documentation for all elements listed in Saf-C 5920.01(e) with a list of the licensed providers trained pursuant to Saf-C 5920.(d) The form shall be signed and dated by the head of unit, as the applicant, and the MRH medical director, or designee.N.H. Admin. Code § Saf-C 5920.02
(See Revision Note at chapter heading for Saf-C 5900) #7690, eff 5-21-02, EXPIRED: 5-21-10
Source. #9779-A, eff 9-8-10
Amended by Volume XXXIX Number 24, Filed June 13, 2019, Proposed by #12790, Effective 5/24/2019, Expires 5/24/2029.