Health Licensing
Forms Related to Licensing and Operating a Health Care Facility or Activity
Licensing/Permitting Applications
- Body Piercing Facility - Application for Permit (doc)
- Community Residential Care Facility - Application for License to Operate (doc)
- Hearing Aid Specialist - Application for License (doc)
- Hearing Aid Specialist - Examination To Be Eligible For Licensure (pdf)
- Hearing Aid Specialist - Temporary Permit Under Sponsorship of a Licensed Hearing Aid Specialist Application (doc)
- Inpatient Care Facility (pdf) - Application for License to Operate - Use This Application For Facilities that Treat Individuals for Psychoactive Substance Abuse or Dependence; Hospice Inpatient Facilities; Hospitals and Institutional General Infirmaries; Intermediate Care Facilities for Persons with Intellectual Disability; Nursing Homes; Residential Treatment Facilities for Children and Adolescents
- Midwifery - Application for License to Provide Services (doc)
- Outpatient Care Activity or Service (pdf) - Application for License to Operate - Use This Application For Abortion Clinics; Ambulatory Surgical Facilities; Birthing Centers; Day Care Facilities for Adults; Freestanding or Mobile Technology; Outpatient Facilities that Treat Individuals for Psychoactive Substance Abuse or Dependence; Home Health Agencies; Outpatient Hospices; Renal Dialysis Facilities
- Tattoo Facility - Application for Licensing (doc)
Licensing Forms
- Hospital Perinatal Information (doc)
- Freedom of Information Request Form (pdf)
- Request for Consideration of Cited Violation (doc)
- Request for Consultation/Assistance (pdf)
- Request for Exception to Licensing Standard (doc)
For additional information, contact: Division Director Gwendolyn Thompson - (803) 545-4370