Licensure Applications

• Ambulatory Surgical Treatment Center Application*
  • License Fees for Ambulatory Surgical Treatment Centers
• Application for Health Care Facility License*
• Assurance of Compliance with the Department of Health and Human Services Regulation*
• Complaint Form (Submit it Online)
• Department of Health Certification*
• Disclosure of Ownership and Control Interest Statement*
• Group Homes for Mentally Retarded Persons*
• Hospital Licensure Application*
• Hospital Request for Certification in the Medicare/Medicaid Program*
• Insurance Verification Request*