Which template should my facility use?  

The table below provides guidance regarding which template to use for each industry.

Group Provider Type Template Name in pdf format Template Name in Word format
Independent Hospital  Inpatient Facility Plan Template Inpatient Facility Plan Template
Critical Access Hospital  Inpatient Facility Plan Template Inpatient Facility Plan Template
Long Term Care Facility   Inpatient Facility Plan Template Inpatient Facility Plan Template
Psychiatric Residential Treatment Facility (PRTF)   Inpatient Facility Plan Template Inpatient Facility Plan Template
Intermediate Care FAcility for Individuals with Intellectual Disabilities (ICF/IID)   Inpatient Facility Plan Template Inpatient Facility Plan Template
Religious NonHealthcare Institution (RNHCI) No RNHCI in Louisiana NO RHNCI in Louisiana
Transplant Center (are embedded in a HOSPITAL)   Inpatient Facility Plan Template Inpatient Facility Plan Template
       
 Outpatient Hospice  Hospice Plan Template Hospice Plan Template
Ambulatory Surgical Center  ASC Plan Template ASC Plan Template
Program for the All-Inclusive Care of the Elderly (PACE)  PACE Plan Template PACE Plan Template
Home Health Agency  Home Health Plan Template Home Health Plan Template
Comprehensive Outpatient Rehabilitation Facility (CORF)  CORF Plan Template CORF Plan Template
Community Mental Health Center (CMHC)  CMHC Plan Template CMHC Plan Template
Organ Procurement Organization (OPO)  OPO Plan Template OPO Plan Template
Clinics, Rehabilitation, and Therapy  Clinic Plan Template Clinic Plan Template
Rural Health Clinic (RHC)/ Federal Qualified Health Center (FQHC)  RHC FQHC Plan Template RHC FQHC Plan Template
End Stage Renal Disease (ESRD)   ESRD Plan Template ESRD Plan Template