ODH-698 Hospital & ASC Plan Review Submittal Application Form
ODH-696 Plan Review Submittal Application Form
New Forms Effective 10/01/2017
Plan Review Checklist
Ambulatory Surgical Center Self Certification Application
Ambulatory Surgical Center Waiver Request
Continuum of Care & Assisted Living Center Self Certification Application
Continuum of Care & Assisted Living Center Waiver Request
Hospital Self Certification Application
Hospital Waiver Request
Nursing Facility Self Certification Application
Nursing & Specialized Facilities Waiver Request
Res Care Self Certification Application
Consultation Services Request Hospitals and Ambulatory Surgical Centers
Consultation Services Request Long Term Care
Courtesy Inspections for Hospitals and Ambulatory Surgical Centers
Courtesy Inspections Long Term Care Facilities
Fees:$250.00 up to and including $2,000.00 (dependent upon construction cost) for plan reviews for hospital and inpatient hospice construction. Fees are assessed for plan reviews of Long Term Care Nursing and ICF/MR Facilities construction plans showing an increase in beds in an amount not more than two one-hundredths percent (0.02%) or one thousand dollars ($1,000.00), whichever is least, per project of total construction.
