Instafill.ai
7 days free
AI form filling · 204 fields · 7 pages · done in seconds

Yes! You can use AI to fill out Health Assessment – Ontario Health atHome (Fixing Long-Term Care Act, 2021) (Form 4768-69E)

Don't type 204 fields by hand. Tell our AI about yourself, or upload your insurance card, and it fills every field in seconds. You check it, then download, print or sign.

7 days free, then $19.99/month · Cancel anytime
AI fills it, no typingEncrypted, never used to train AICancel in two clicks
Health Assessment – Ontario Health atHome (Fixing Long-Term Care Act, 2021) (Form 4768-69E), page 1
Complex · 70/100Form Complexity Index

The AI does the filling. You just check it.

No typing into boxes, nothing to install.

Tell the AI about youAnswer a few questions in plain words, or upload your insurance card. That is all the typing there is.
AI fills every field in secondsIt puts each answer in the right box on every page, checkboxes included.
Check it and downloadReview every field, change anything, then download, print or sign the PDF.

What this form asks for

The AI fills all of it, from your answers or your documents.

The Health Assessment – Ontario Health atHome (Form 4768-69E) is an official Ontario Ministry of Long-Term Care form required under the Fixing Long-Term Care Act, 2021 when someone applies for a determination of eligibility for admission to a long-term care home. It captures key clinical information (diagnoses, medications, allergies, vaccinations, responsive behaviours, wounds, TB/ARO screening, and medical devices) that Ontario Health atHome uses to assess eligibility and that long-term care homes use to determine whether they can safely meet the applicant’s care needs. The form must be completed and signed by an authorized practitioner (physician, RN in the general class, or RN in the extended class) and submitted to Ontario Health atHome, often with supporting documentation. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
Fillable fields204
Pages7
Sections58
Questions that depend on earlier answers68
Form Complexity IndexComplex, 70/100

The AI checks your answers before you download

16 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Status of Assessment selection is mutually exclusive and required

Validates that exactly one of "Initial Assessment" or "Reassessment" is selected. This is critical because downstream required sections and conditional fields depend on the assessment type. If both or neither are selected, the submission should be rejected and the user prompted to choose one status before continuing.

Reassessment requires previous assessment date in YYYY/MM/DD and not in the future

When "Reassessment" is selected, checks that "Date of previous assessment" is provided, matches the required YYYY/MM/DD format, and is not a future date. This ensures the reassessment is anchored to a real prior submission and supports auditability. If invalid or missing, block submission and request a corrected date.

Change-since-previous-assessment response required for reassessments and must be single-choice

If "Reassessment" is selected, validates that exactly one of "Yes — Change since previous assessment" or "No — Change since previous assessment" is selected. This drives which clinical sections must be completed and prevents incomplete reassessments from being processed incorrectly. If both/neither are selected, fail validation and require a single clear answer.

Applicant identity fields complete and consistent across repeated headers

Validates that Applicant Last Name, Applicant First Name, and Health Card Number are present and that repeated occurrences of these fields across pages match exactly. This prevents record fragmentation and mis-association of clinical details to the wrong person. If mismatches are detected, reject submission and require reconciliation to a single consistent identity.

Applicant date of birth format and plausibility check

Checks that Date of Birth is in YYYY/MM/DD format and represents a plausible date (e.g., not in the future and not unreasonably old such as >120 years). This reduces data entry errors that can affect eligibility workflows and clinical risk calculations. If the date fails format or plausibility, require correction before acceptance.

Ontario Health Card Number and Version Code format validation

Validates that the Health Card Number contains the expected number of digits for Ontario (typically 10 digits) and that the Version Code, if provided, matches expected format (commonly two letters). This is important for accurate identification and to avoid claim/verification failures. If the number/version code is malformed, flag as an error and prevent submission until corrected.

And 10 more checks
  • Health card expiry date format and logical relationship to submission and DOB
  • Gender selection is single-choice; 'Other' requires specification
  • Applicant mailing address completeness and Canadian postal code format
  • Telephone and fax number formatting for contact and provider fields
  • Medical Diagnoses section requires either attachment indicator or entered diagnoses
  • Current Medications section requires attachment indicator or medication list; attachment flags must not conflict
  • Oxygen therapy logic: Yes/No required; if Yes then source and flow details must be coherent
  • Allergies response required; if 'Yes' then allergy details must be provided
  • Vaccination date fields must be valid dates and not in the future (when provided)
  • TB screening workflow completeness and conditional chest x-ray documentation

Let AI fill out your 4768-69E

No typing. Every field filled in seconds, checked, ready to sign.

7 days free, then $19.99/month · Cancel anytime

How to Fill Out 4768-69E Online for Free in 2026

What the AI walks you through.

  1. Go to Instafill.ai and upload the Health Assessment – Ontario Health atHome form (4768-69E) or select it from the form library.
  2. Choose the assessment type (Initial Assessment or Reassessment) and, if reassessment, enter the prior assessment date and indicate whether there has been a change in health status.
  3. Enter the applicant’s identification details (name, date of birth, Ontario health card number/version/expiry, gender) and mailing address.
  4. Complete the clinical sections: medical diagnoses (or indicate a cumulative patient profile is attached), advance care planning details, current medications/oxygen use, and any recently discontinued drugs.
  5. Fill in risk and care management sections including allergies, vaccination dates, substance use disorder details (and treatment/pharmacy contacts if applicable), responsive behaviours, and wounds/wound care specialist information.
  6. Complete screening and equipment sections (TB symptom and risk factor screens, ARO screening results/actions, and medical/assistive devices with specifications), then enter practitioner information and e-sign/date the form.
  7. Use Instafill.ai to validate required fields, attach supporting documents (e.g., cumulative patient profile, consult notes, x-ray/ARO results), and export for submission (fax or other method) to the local Ontario Health atHome office.

Common Mistakes in Completing 4768-69E

The ones the AI is built to catch.

Selecting the wrong assessment status (Initial vs. Reassessment)
People often tick “Initial Assessment” out of habit, even when they previously submitted an assessment for the same applicant, or they choose “Reassessment” without providing the required prior-date details. This can cause Ontario Health atHome to treat the submission incorrectly, leading to follow-up requests or delays in eligibility determination. To avoid this, confirm whether you (the current practitioner) have previously completed this form for the applicant and select the correct status; AI-powered tools like Instafill.ai can prompt the right branch and prevent incompatible selections.
Incomplete reassessment logic (missing prior date and change/no-change pathway)
On reassessments, submitters frequently forget the “date of previous assessment submitted” or fail to indicate whether there has been a change in health since the last assessment. The consequence is an unclear reassessment record and potential rejection or requests for clarification, especially if only partial sections are completed. Avoid this by always entering the prior submission date (yyyy/mm/dd) when known and explicitly selecting “Yes—change” or “No—no change,” then completing only the sections required by that choice; Instafill.ai can enforce conditional completion rules.
Health card number/version code/expiry entered incorrectly
A very common error is transposing digits in the Ontario health card number, omitting the version code letters, or entering the expiry date in the wrong format. These mistakes can prevent accurate matching to the applicant’s record and trigger administrative back-and-forth. Always copy directly from the card, double-check digit count and version code, and use the required yyyy/mm/dd date format; Instafill.ai can validate formats and flag mismatches before submission.
Gender section left ambiguous (multiple boxes checked or “Other” not specified)
Applicants sometimes have more than one gender option checked, or “Other” is selected without completing the “please specify” field. This creates ambiguity in the record and can lead to data quality issues or follow-up questions. Ensure exactly one option is selected, and if “Other” is chosen, provide a clear specification; Instafill.ai can prevent mutually exclusive selections and require the dependent “specify” field.
Mailing address fields misused (PO Box vs street, rural fields, postal code format)
People often put a full street address into the PO Box field, omit unit numbers, or enter a postal code in a non-Canadian format (or without the correct spacing). Incorrect addresses can cause missed correspondence and delays in coordinating placement. Use the correct field for the address type (street vs PO Box vs rural route/lot/concession) and enter the postal code in Canadian format (e.g., A1A 1A1); Instafill.ai can standardize and format addresses automatically.
Checking “profile/med list attached” but not actually attaching it (or not faxing attachments)
A frequent issue is indicating that a cumulative patient profile or medication list is attached, but the attachment is missing—especially when submitting by fax and forgetting to fax the supporting pages. This can leave key clinical details absent and may delay long-term care home review or require resubmission. Before sending, verify that every checked “attached” item is included in the same submission package; if the form is handled as a flat/non-fillable PDF in your workflow, Instafill.ai can convert it into a fillable version and help track required attachments.
Medical diagnoses too vague or incomplete (missing active vs historical relevance)
Submitters often write broad terms (e.g., “dementia,” “heart disease”) without specifying active conditions, severity, or relevant history when no cumulative profile is attached. This reduces the usefulness of the assessment for determining care needs and can lead to inappropriate placement decisions or additional information requests. Provide active diagnoses plus relevant historical diagnoses with context (severity, current status, key complications) or attach the cumulative patient profile; Instafill.ai can prompt for missing clinical context and ensure the “attached vs listed” choice is consistent.
Medication list missing non-prescription items, doses, routes, or priority medication details
People commonly list only prescriptions and omit OTC medications, supplements, PRNs, or key details like dose, frequency, and route. Long-term care homes rely on this for continuity of care, and missing information can create medication reconciliation risks and delays at admission. Include all current meds (Rx/OTC/supplements where known) and clearly identify priority classes (benzodiazepines, antipsychotics, other psychotropics, opioids, diuretics/antiglycemics) with purpose; Instafill.ai can format medication entries consistently and flag incomplete fields.
Oxygen therapy section completed inconsistently (Yes checked but no type/rates)
A common mistake is checking “Oxygen—Yes” but leaving the source (tank/concentrator/unknown) and flow rates blank, or entering rates without units. This can lead to unsafe assumptions about respiratory support needs and follow-up calls for clarification. If oxygen is used, specify source and whether continuous vs exertion/PRN, and enter flow rates in L/min; Instafill.ai can require the dependent fields and enforce unit-aware formatting.
Allergies marked “Yes” without reaction/severity details (or “Not known” used too broadly)
Many forms indicate severe allergies but fail to describe the allergen, reaction type, severity, and whether an EpiPen is required. This can create safety risks and forces receiving teams to chase details. When “Yes,” always document trigger(s), reaction, severity, and management; if truly unknown, use “Not known” rather than guessing—Instafill.ai can prompt for the required allergy detail fields when “Yes” is selected.
TB screening pathway errors (symptoms vs risk factors, missing chest x-ray attachment when required)
Submitters sometimes skip the symptom screen status, mark “Yes—Chest x-ray required” without attaching results, or fail to proceed to the risk factor screen when symptoms are absent/negative. This can make the TB screening section non-compliant and delay processing. Follow the sequence: complete symptom screen, attach chest x-ray results only when symptomatic, then complete risk factor screening where possible; Instafill.ai can guide the conditional workflow and prevent incomplete TB sections.
Missing practitioner designation, signature, or signature date
Even when clinical sections are complete, forms are often submitted without selecting the practitioner designation (Physician/RN/RN(EC)), without a signature, or without the date in yyyy/mm/dd format. Unsigned or undated assessments may be considered invalid and can halt the eligibility determination process. Always complete practitioner identity, designation, contact details, then sign and date on the last page; Instafill.ai can highlight missing signature/date fields and validate date formatting before submission.

Frequently Asked Questions About 4768-69E

 

Is it really free for 7 days?
Yes. You pay $0 today. Cancel before Nov 12 and you are never charged. Keep it, and it is $19.99 a month for 5 fills of your 4768-69E.
Can I fill other forms too?
This plan is for your 4768-69E: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.
How do I cancel?
From your account, in two clicks, any time. No email, no call.
How does the AI fill out 4768-69E?
You answer a few questions in plain words, or upload your insurance card. The AI reads what you give it and puts each answer into the right field of 4768-69E, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is 4768-69E to fill out?
4768-69E has a Form Complexity Index of 70 out of 100, in the complex tier: 204 fillable fields across 7 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the Health Assessment – Ontario Health atHome form used for?
This form documents the health assessment required under the Fixing Long-Term Care Act, 2021 when someone applies to be determined eligible for admission to a long-term care home. Ontario Health atHome uses it as part of the eligibility and placement process.
Who is allowed to complete and sign this health assessment?
The assessment must be completed by a physician or a registered nurse in the general class, or a registered nurse in the extended class (RN(EC)). The practitioner must sign and date the last page.
Do applicants fill out this form themselves?
Most clinical sections are completed by the practitioner, but the applicant (or family/substitute decision maker) may provide information such as medications, allergies, and advance care planning details. The applicant’s identifying information must be accurate and match health records.
What’s the difference between an Initial Assessment and a Reassessment?
Choose “Initial Assessment” if this is the first time this practitioner is completing the form for the applicant and complete all sections. Choose “Reassessment” if the same practitioner previously submitted an assessment for the applicant and is updating it.
If this is a reassessment, do I need to complete the whole form again?
If the applicant’s health has changed, complete Applicant Information, Practitioner Information, and only the sections that reflect the change. If there is no change, complete Applicant Information and Practitioner Information and sign the last page.
Where do I send the completed form, and can it be faxed?
Return the completed form to the local Ontario Health atHome office listed in the “Return completed form to” section (often by fax). If submitting by fax, include any additional documents you want considered with the assessment.
What information is required in the Applicant Information section?
You must provide the applicant’s name, date of birth, Ontario health card number (including version code and expiry), gender selection, and mailing address. Enter details exactly as they appear on official/medical records to avoid delays.
Do I need to attach a cumulative patient profile, and what if I don’t have one?
Attaching a cumulative patient profile is strongly encouraged when available, but it’s not mandatory. If you don’t attach it, you must list active and relevant historical medical diagnoses directly on the form.
What supporting documents can be attached to help the long-term care home understand care needs?
You can attach items like geriatric/psychogeriatric assessments, specialist consult notes, test results, hospital discharge summaries, OT/PT notes, speech/swallowing reports, social work notes, GAIN assessments, and goals of care. The form notes it will be assumed consent was obtained where required to share attachments.
How detailed should the Current Medications section be?
Provide a comprehensive list of all current medications, including prescriptions, non-prescription drugs, and supplements (where known). The form emphasizes priority medications (e.g., benzodiazepines, antipsychotics/psychotropics, opioids, diuretics/antiglycemics) and asks for name and purpose when prescribed.
How do I complete the oxygen therapy fields?
Indicate whether the applicant uses oxygen, then specify the source (tank, concentrator, or unknown) and whether it is continuous or with exertion/as required. Include the flow rate in L/min for the applicable category.
What should be included for allergies and vaccinations if dates are unknown?
For allergies, select Yes/No/Not known and provide reaction/severity details if “Yes.” For vaccinations, enter dates where known or rely on an attached cumulative patient profile if it contains the information.
Is a TB chest x-ray required for every long-term care applicant?
No—this form states the Ministry removed the requirement for a TB chest x-ray for all applicants and requires it only for symptomatic individuals. If symptoms are present, a chest x-ray is required and results should be attached; otherwise proceed to the risk factor screen.
Can AI tools help fill out this form, and how would Instafill.ai help?
Yes—AI tools can help reduce manual entry and errors by auto-filling fields from provided information. Services like Instafill.ai use AI to accurately populate form fields, saving time for clinics and applicants.
How do I fill this form online using Instafill.ai, and what if the PDF isn’t fillable?
Upload the PDF to Instafill.ai, provide the applicant/practitioner details and any supporting documents, and the AI will map and auto-fill the fields for review before you download and submit. If the PDF is flat/non-fillable, Instafill.ai can convert it into an interactive fillable form so you can complete it digitally.
Encrypted in transit and at restNever used to train AIDelete your forms any time

Get your 4768-69E filled out by AI

$0 today. Cancel before Nov 12 and you pay nothing.

Other forms like this one

CAR forms: Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event, Form I-90, Application to Replace Permanent Resident Card, Form 2441, Child and Dependent Care Expenses, Form WH-380-E, Certification of Health Care Provider, Form 4137, Social Security and Medicare Tax on Unreported Tip Income, Form 8959, Additional Medicare Tax, Form 8919, Uncollected Social Security and Medicare Tax, Form CMS-1763, Request for Termination of Medicare Coverage, Form CMS-855O, Medicare Enrollment Application, Form CMS-460, Medicare Participation Agreement, Form CMS-4040, Request for Enrollment in Medicare Part B, Form WH-380-F, Certification of Health Care Provider, Form W-10, Dependent Care Provider’s Identification, Form 1099-K, Payment Card and Third Party Network Transactions, Form CMS-40B, Application for Enrollment in Medicare Part B, Form SS-5-FS, Application for a Social Security Card, Form REG 195, Disabled Person Placard, Form AR-11, Alien's Change of Address Card, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, Form I-131A, Application for Carrier Documentation

health care forms: Form WH-380-E, Certification of Health Care Provider, Form WH-380-F, Certification of Health Care Provider, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), Prior Authorization (PA) Request Form – Adult Palliative Care (Alameda Alliance for Health), Medicare Enrolment Application (Australia) – Enrol in Medicare, Re-enrol/Extend Eligibility, Enrol a Newborn, and Register for My Health Record, Alameda Alliance for Health Prior Authorization (PA) Request Form – Adult Palliative Care, Health Assessment - Ontario Health atHome (Fixing Long-Term Care Act, 2021) — Form 4768-69E, Request for Transfer of Records (Adelaide Health Care) – AHC-0013-05-PS (Version 2), Application for Access to Health Care Records (Nepean Blue Mountains Local Health District) – NBMA-431, L.A. Care Behavioral Health Treatment Applied Behavioral Analysis Authorization Request Form, Medicaid Managed Care Applied Behavior Analysis — Authorization Request (Healthy Blue Louisiana, BLAPEC-1989-20), Iowa Advance Directive: Durable Power of Attorney for Health Care and Declaration (Living Will), Direct Rollover Request for Appalachian Regional Healthcare, Inc. Voluntary Plan, Molina Healthcare Prior Authorization Request Form, UnitedHealthcare Prior Authorization Request Form, Optum Rx / UnitedHealthcare Prior Authorization Request Form, Texas Standard Prior Authorization Request Form for Health Care Services, Form T-3, Children with Special Health Care Needs (CSHCN) Services Program Application

ACT Health forms: Health Assessment - Ontario Health atHome (Fixing Long-Term Care Act, 2021) — Form 4768-69E, Discovery Health Practice Registration Form 2026 (DHHPR2001), Contra Costa Environmental Health Division Body Arts Practitioner Application, Form CARE-101, Mental Health Declaration—CARE Act Proceedings, Form CARE-102, Petition to Begin CARE Act Proceedings By Licensed Behavioral Health Professional Only, Form HC-002, Petition for Writ of Habeas Corpus—LPS Act (Mental Health), Form WH-380-E, Certification of Health Care Provider, Form CMS-1561, Health Insurance Benefit Agreement

L.A. Care forms: Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event, Form 2441, Child and Dependent Care Expenses, Form WH-380-E, Certification of Health Care Provider, Form 4137, Social Security and Medicare Tax on Unreported Tip Income, Form 8959, Additional Medicare Tax, Form 8919, Uncollected Social Security and Medicare Tax, Form CMS-1763, Request for Termination of Medicare Coverage, Form CMS-855O, Medicare Enrollment Application, Form CMS-460, Medicare Participation Agreement, Form CMS-4040, Request for Enrollment in Medicare Part B, Form WH-380-F, Certification of Health Care Provider, Form W-10, Dependent Care Provider’s Identification, Form CMS-40B, Application for Enrollment in Medicare Part B, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), California Department of Social Services (CDSS) Community Care Licensing Child Care Forms Packet (LIC 9150, LIC 282, LIC 627, LIC 700, LIC 995A, CDPH 286, LIC 9227), State of Illinois Department of Human Services (IDHS) – Bureau of Child Care and Development Child Care Application (Form IL444-3455), Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years

health forms: Form 1095-A, Health Insurance Marketplace Statement, Form 8889, Health Savings Accounts, Form WH-380-E, Certification of Health Care Provider, Form 7206, Self-Employed Health Ins. Ded., Form 8885, Health Coverage Tax Credit, Form WH-380-F, Certification of Health Care Provider, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, Form 1095-B, Health Coverage, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, Form BHVH, Outpatient Behavioral Health – ABA Treatment Request, Form SHA, Separation Health Assessment, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), Geisinger Health Plan Behavioral Health Professional Services Questionnaire, Priority Health Small Group Renewal Decision Form, Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), Form 7206 (2025), Self-Employed Health Insurance Deduction, HIPAA Authorization Form, Authorization for the Release of Protected Health Information, Prior Authorization (PA) Request Form – Adult Palliative Care (Alameda Alliance for Health), Medicare Enrolment Application (Australia) – Enrol in Medicare, Re-enrol/Extend Eligibility, Enrol a Newborn, and Register for My Health Record, Alameda Alliance for Health Prior Authorization (PA) Request Form – Adult Palliative Care

long term care forms: John Hancock Independent Care Provider Service Reimbursement, Health Assessment - Ontario Health atHome (Fixing Long-Term Care Act, 2021) — Form 4768-69E, Anthem Blue Cross Long-Term Care — Authorization Request Form, Form CMS-1539, Long-Term Care Facility Application for Medicare and Medicaid, Blue Shield of California Promise Health Plan Long Term Care Treatment Authorization Request Form

ERM forms: REQUEST FOR OWNERSHIP INFORMATION—ERM-14 FORM, Form I-90, Application to Replace Permanent Resident Card, Form I-485, Application to Register Permanent Residence, Form SS-8, Determination of Worker Status, Form CMS-1763, Request for Termination of Medicare Coverage, Form I-212, Application for Permission to Reapply, Form I-192, Application for Advance Permission to Enter as a Nonimmigrant, Form W-8IMY (Rev. October 2021), Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding and Reporting, County of Louisa Department of Community Development – New Non-Residential Building Permit Package, Application Schedule 1: Designer Information (City of Toronto Building Permit Application), HR-Pol-Rec&Res-04 Employment Application Form (Recruitment of Permanent Employees), Fauquier County Department of Community Development – Building Trades Permit or Amendment to Existing Permit Application (Residential or Commercial), Belastingdienst VPB 075 – Verzoek fiscale eenheid Vennootschapsbelasting (Deel A – Gegevens moedermaatschappij), ROTC Cadet Academic Plan / Degree and Credit Hour Worksheet (Student Identification, Term-by-Term Courses, GPA Summary, and Completion Certification), Health Assessment - Ontario Health atHome (Fixing Long-Term Care Act, 2021) — Form 4768-69E, Washington Single-Family Property Term Lease & Security Deposit Receipt (WA Single-Family Lease) | Revised 10/08/2025, Application for Mechanical Permit, Pennsylvania Department of State — Certificate of Termination (Domestic Limited Liability Company) (15 Pa.C.S. § 8872(f)) (DSCB:15-8872(f)), Document Checklist for a Study Permit (IMM 5483), City of Raleigh Residential Permit Application (Revision 08-20-2025)

7 days free, then $19.99/month · Cancel anytime