Healthcare Facilities Licensing Applications

• Abortion Facility (D-3312)
• Adult Day Care Facility (D-3287)
• Ambulatory Surgical Facility (D-3288)
• Birthing Center (D-3311)
• Body Piercing Facility (D-0264)
• Community Residential Care Facility (D-0217)
• Freestanding or Mobile Technology (D-3310)
• Hearing Aid Specialist:
  • Application for Examination (D-0220)
  • Application for License (D-0221)
  • (Application for Temporary Permit (D-0222)
• Home Health Agency (D-3289)
• Hospice:
  • Hospice Facility (Inpatient) (D-3290)
  • Hospice Facility (Outpatient) (D-3291)
• Hospital or Institutional General Infirmary (D-3292)
• Immediate Care Facility for Persons with Intellectual Disability (D-3321)
• In-Home Care Provider (D-1307)
• Midwifery:
  • Licensed Midwives (D-0252)
  • Midwife Apprentice (D-3977)
• Nursing Home (D-3294)
• Renal Dialysis Facility (D-3296)
• Residential Treatment Facility for Children and Adolescents (D-3297)
• Chemically Dependent or Addicted Persons Treatment Facility:
  • Outpatient Facility or Narcotic Treatment Program (Outpatient) (D-3295)
  • Residential Treatment Program Facility, Medical Detoxification Facility, or Social Detoxification Facility (Inpatient) (D-3293)
• Tattoo Facility (D-0234)

Other Forms (pdf)

• Hospital Perinatal Information (D-0281)
• Freedom of Information Request (D-2295)
• Request for Consideration of Cited Violation
• Request for Consultation/Assistance
• Request for Exception to Licensing Standard

For additional information, contact: Division Director Gwendolyn Thompson - (803) 545-4370