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Long Term Care Forms



All Facilities

  • Covered facilities are skilled nursing facilities, nursing facilities, and dually-participating SNF/NF
  • All documentation containing resident-identifying information must be redacted
  • An IIDR can be requested for deficiencies with a scope and severity of "G" or above that lead to the imposition of a Civil Monetary Penalty (CMP) and for which notice has been provided to the nursing home that the CMP will be collected and placed in escrow
  • CMS may collect imposed Civil Monetary Penalties (CMPs) and place them in an escrow account
  • You must request the IIDR within 10 calendar days of CMS Initial Imposition Notice

Skilled Nursing Facilities/Nursing Facilities/Dually-Participating SNF/NF: IIDR Request Form 833A

Assisted Living Centers

Nursing Homes


Contact Information:

Mailing Address:
Oklahoma State Department of Health
Long Term Care Services
123 Robert S. Kerr. Ave Suite 1702
Oklahoma City, OK 73102-6406

Physical Address:
Oklahoma State Department of Health
Long Term Care Services
123 Robert S. Kerr. Ave
Oklahoma City, OK

Phone: (405) 426-8200
Fax: (405) 444-6428
Email: LTC@health.ok.gov

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