RNHA

Name of Nursing Home / Clinic / Hospital:
?	*
Address:
line 1	*
line 2
line 3
town	*
post code	*
Telephone:
?	*
Fax:
?
Email:
?	*

Name of Local Authority:
?	*
Local Office Commission for Social Care Inspection (CSCI):
?	*

Proprietor(s):
?	*
Status:
?	*
Premises Registered for How Many Patients?:
?	*
Registration Category Details:
?	*

Insurance Company:
?	*
Renewal Date:
?	*

Please list names and addresses of all care homes
providing nursing care registered under your ownership:*

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