This government document is issued by Department of Community Health for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://dch.georgia.gov/document/document/nursing-home-application-packet/download&sa=U&ved=2ahUKEwi3p-2uzJaHAxVJSEEAHfh0ByM4HhAWegQIAxAB&usg=AOvVaw3mOtu3ZhZoeeD0JUUVdMFq&fexp=72519171,72519168