Florida Department of State and Division of Library and Information Services

Reference: Ref-14000

Reference Name: Income and Expense Statement AHCA Form 3180-1017 August 2021
Agency: 59 Agency for Health Care Administration
59A Health Facility and Agency Licensing

Modified Document(s):
3/1/2022 Removed watermark
Original Document(s):
1/12/2022 hard copy form to be incorporated in 59A-37.002
Description: hard copy form to be incorporated in 59A-37.002

Disclaimer: External links within the reference material are subject to change outside of the rulemaking process.

Rules/Notices using this Reference Material
Notice /
Adopted		 Section Description ID Publish
Date
View Text Final
59A-37.002 		License Application, Renewal and Conditional Licenses 25565919 Effective:
02/27/2022



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