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Facility Services Division Licensure Applications and Related Forms

Hospital Applications and Forms

  • ODH-920 Application for License to Operate a Hospital (22k.pdf)
  • ODH-892 Board of Directors Information Sheet (11k.pdf)
  • ODH-911 Hospital Emergency Medical Services Classification Report (13k.pdf)
  • ODH-928 Life Safety Code Inspection Report for Hospitals (28k.pdf)
  • ODH-929 Hospital Designation of Licensed Beds (11k.pdf)
 

Ambulatory Surgical Centers Applications and Forms

  • ODH-909 Application for License to Operate an Ambulatory Surgical Center
 

Workplace Drug & Alcohol Testing Facilities Applications and Forms

  • ODH-912 Drug and Alcohol Testing Facility Application (28k.pdf)
  • Workplace Drug and Alcohol Application Checklist 
 

Home Care Application Forms

  • ODH-1273 Application for License to Operate a Sitter or Companion Service Agency. (56k.pdf)
  • ODH-757 Application for License to Operate a Home Care Agency. (67.6k.pdf)
  • ODH-758 Application for Initial Home Care Branch
 

Hospice Application Forms

  • ODH-924 Application for License to operate a Hospice. (56k.pdf)

  • ODH-659 Application for Hospice Alternative Administrative Office. (50k.pdf)
 

Tissue and Eye Banks - Anatomical Gifts Application and Forms

  • ODH-756 Application for Permit to operate a Tissue Bank or Eye Bank (111k.pdf)
  • ODH-942 Certificate of Request for Anatomical Gift (49k.pdf) (obsolete)
 

Initial licensure packets are now available at no charge.  To order an initial licensure packet for one of the above mentioned licensed facilities, please contact our office at the following address:

Medical Facilities Service
Oklahoma State Department of Health
123 Robert S Kerr Ave, Ste. 1702
Oklahoma City, OK 73102
Phone: (405) 426-8470 or (405) 426-8467
medicalfacilities@health.ok.gov

Initial Medicare Certification

On April 10, 2007 the Oklahoma State Department of Health (OSDH) received guidance from the Centers for Medicare & Medicaid Services (CMS) Region VI office in Dallas, TX that emphasized the expectation that OSDH would abide by the workload priorities established in the CMS Mission + Priority Document that outlines the terms of the contract between CMS and OSDH for Medicare certification activity in Oklahoma. OSDH was reminded that initial Medicare surveys are categorized as Tier IV workload and therefore, have the lowest priority of all certification work. OSDH was directed to not conduct initial Medicare surveys unless and until all higher priority work has been completed or can be predicted to be complete by the end of the home health providers and new alternate administrative delivery site locations for hospice providers are also considered Tier IV workload. Copies of related written correspondence between the CMS Region VI
office and OSDH are linked here for information purposes.
 

  • CMS Letter to OSDH re: Initial Certification Workload dated 04/10/2007



 


 

Special Announcements

All licensing fees must accompany the completed application form and be mailed to the following address: Financial Management-Receipting Unit, OSDH, PO Box 268823, Oklahoma City, OK 73126-8816, Failure to do so may result in a delay in the processing of your license application.
 
 

Related Topics

Contact Information:

Mailing Address:
Oklahoma State Department of Health
Medical Facilities
123 Robert S. Kerr. Ave Suite 1702
Oklahoma City, OK 73102-6406

Physical Address is:
Oklahoma State Department of Health
Medical Facilities
123 Robert S. Kerr. Ave
Oklahoma City, OK

Phone: (405) 426-8470
medicalfacilities@health.ok.gov

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