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Home Services Division Licensure Applications and Forms

Application Guidance Letters

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)

CMS - The Centers for Medicare and Medicaid Services Forms

Additional Assistance

Licensure Meetings

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.

Frequently Asked Questions

Q: What if my application is incomplete?
A: The Home Services Division will work with you in order to facilitate a complete application. If the application is not complete and fails to meet all requirements for an initial survey, your application may be summarily dismissed.

Q: What is the purpose of the initial licensure on-site survey?
A: To determine if an agency meets the minimum requirements to receive a home care/ hospice or Companion Sitter license.

Q: What does it mean to have deficiencies cited at the initial licensure on-site survey?
A: A deficiency means that a minimum requirement was not met, and the agency would receive a written statement of deficiency report. The agency must provide a written plan of correction for review, in response to each cited deficiency.

Contact Information

Mailing Address:
Oklahoma State Department of Health
Medical Facilities Service
Attn: Home Services Division
123 Robert S. Kerr Ave., Ste 1702
Oklahoma City, OK 73102-6406

Physical Address:
Oklahoma State Department of Health
123 Robert S. Kerr Ave.
Okalhoma City, OK 73102

Telephone: (405) 426-8470
Fax: (405) 900-7559

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