Licensure Applications

NOTICE Due to recent system upgrades, there will be a temporary disruption in our ability to print renewal notices between April and June 2024. As a result, you may receive your license renewal notice earlier than usual. This is only applicable to renewal notices, not the physical license. Those receiving an early renewal notice have been contacted via the method of contact they have on file with their board. Please see the Early Renewal FAQ for additional information.

Renewal Application for License for Adult Care Home

Renewal Application for License for Ambulatory Surgical Treatment Center

Renewal Application for License for Assisted Care Living Facility

Renewal Application for Certification for ACLF/RHA Administrator

Renewal Application for License for Birthing Centers

Renewal Application for License for End Stage Renal Dialysis Clinics

Renewal Application for License for HIV Supportive Living Facility

Renewal Application for License for Home for Aged

Renewal Application for License for Home Health Agency

Renewal Application for License for Home Medical Equipment Provider

Renewal Application for License for Hospice

Renewal Application for License for Hospital

Renewal Application for License for Nursing Home

Renewal Application for License for Outpatient Diagnostic Treatment Center

Renewal Application for License for Prescribed Emergency Child Care Center

Renewal Application for License for Professional Support Services Provider

Renewal Application for License for Residential Hospice

Renewal Application for License for Traumatic Brain Injury (TBI) Residential Home

Complaint/Investigation Intake Report

**Please see the HFC Filing a Complaint page for further information on how to submit your complaint.

Trauma Center Application (PH-4209)

**Please see the Trauma Page for further information**