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The Health Facility Systems staff receives and processes applications for licenses, renewals, and amendments.
Note: Files on this page have been converted to .PDF. You will need the Adobe™ Acrobat ™ Reader to view them. A short-cut is provided on the left in the blue column.
HRDS-HFS2012-02 Renewal License – Expiration Date Change (June 18, 2012)
Nursing Home Care Act (Title 63 O.S. Section 1-1901 et seq.)
Chapter 675, Nursing and Specialized Facilities (OAC 310:675)
Note: The following files make up the License Application and its attachments.
ODH Form 953-B, Disclosure Statement Of Owner, Lessee and Manager for a Long-Term Care Facility (1M)
ODH Form 953-C, Detail Attachment To the Disclosure Statement (84K)
ODH Form 953-D, Affirmation Attachment To the Disclosure Statement (72K)
ODH Form 953-E, Staffing Projection And Professional Certification For A Nursing Or Long-term Care Facility (84K)
ODH Form 613, Alzheimer's Disease or Related Disorders Special Care Disclosure
ODH Form 661, Qualified Temporary Manager Application (64K)
Note: The applicable form below is required for an applicant applying for a license as an individual.
ODH Form 266, Affidavit of Lawful Presence by Guardian of Person Making Application for a License, Permit or Certification (32K)
ODH Form 301, Affidavit of Lawful Presence by Person Making Application for a License, Permit or Certification (29K)
ODH Form 958, Notice of Change (1M)
ODH Form 953-F, Periodic Report for Suspended License for a Long-Term Care Facility (60K)
Long Term Care Facility Directory
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