Health Facilities Licensing

Licensure Application Information

The link below applies to all facility and license/permit types and contains important instructions for completing your new application.

Use the forms below to assist with required background checks for the following facility types.

Instructions for Owners to Complete Background Check to Obtain a Health Facility License (For Initial of CHOW applications, complete step 1, within the instructions for each designated owner)
Fingerprint Background Waiver Form(must be fully executed for each designated owner and uploaded to the license application)

An agency to provide personal care services in the home (PCS)
Intermediary Service Organizations (ISO)
An agency to provide nursing in the home (HHA)
A facility for intermediate care (ICF)
A facility for skilled nursing (SNF)
A residential facility for groups/assisted living(AGC)
A program of hospice care
A home for individual residential care
A facility for the care of adults during the day
A facility for hospice care
A nursing pool
Medical facilities such as hospitals that provide residential services to children Facilities for the treatment of abuse of alcohol or drugs that provide residential services to children
Hospitals that:
- Plan on becoming federally designated as a long-term acute care hospital
- Plan on having a distinct part skilled nursing facility or nursing facility
- Plan on providing swing-bed services
- Provide residential services to children