All documentation containing resident-identifying information must be redacted.
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
Email: LTC@health.ok.gov