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:*