STATEMENT OF INTENDED USE

The license holder must submit a statement of intended use as part of the license application. The statement of intended use must, at a minimum, meet the requirements in items A to F: A. state the license holder's expertise and qualifications to provide the services noted in the program description; B. describe the target population to be served with consideration of at least the following characteristics of the residents: cultural background, gender, age, medically fragile condition, and legal status, including children in need of protection or services petition status, delinquency, and whether the resident is in the facility as a voluntary placement or self-referral; C. state the primary needs of residents that the license holder will meet in the licensed facility; D. identify those resident services provided within the setting and those services to be provided by programs outside the setting; E. state how the license holder will involve the resident's cultural or ethnic community to ensure culturally appropriate care; and F. describe the specific extent and limitations of the program, including whether the license holder would use a restrictive procedure with a resident, under what conditions a restrictive procedure would be used, and what type of restrictive procedures a license holder would use if the license holder was certified to use restrictive procedures.