Facility Services Division Licensure Applications and Related 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)

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

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

• ODH-756 Application for Permit to operate a Tissue Bank or Eye Bank (111k.pdf)

The Facility Services federal workload is established annually and based on the CMS Mission and Priority Document (MPD). This document prioritizes workload by tiers (Tiers 1 – 4) to ensure timely completion of high priority survey activity which includes surveys for complaints, initial certification, re-certification, and validation. Tiers 1-2 have the highest priority followed by Tiers 3-4 with Tier 4 having the lowest priority. The MPD is released publicly by CMS to inform stakeholders about the agency’s priorities and focus areas for the year. The document is available on the CMS website.

• Certification process
• CMS interpretive guidelines
• CMS - approved accrediting organizations 

• Office for Civil Rights
• Link to the uniform credentialing application
• Link to verify nurse aide & non-technical worker registry
• Frequently Asked Questions