NEW YORK STATE’S REGULATORY ROLE IN NURSING HOMES HEARING
REPLY FORM -- PLEASE RESPOND BY MONDAY, MAY 9, 2005.


Mail to: Assembly Health Committee, Room 822 LOB, Albany, NY 12248
Or fax to: 518-455-5939

box I plan to testify at the May 19, 2005 hearing on the Nursing Home Regulation legislation.

box I plan to attend, but not testify at the May 19, 2005 hearing on the Nursing Home Regulation legislation.

box

I will require assistance and/or handicapped accessibility information. Please specify type of assistance required:



Name:

Title:

Organization (if applicable):

Address:

City/State/Zip:

Telephone:

Fax:

E-mail:
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