Licensure Applications and Forms - Oklahoma State Department of Health

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Home Services Division's Licensure Applications and Forms:

Home Care Agency Licensure Applications and Related Forms:

ODH-Pending # Initial application to open a Sitter or Companion Service Agency (56k.pdf)

ODH-757 New! Revised/Combined Application for License to Operate a Home Care Agency. (Replaces Forms 758, 759, 760 and 776.)

ODH-761 Application for a Home Care Agency pro-rated license renewal (24k.pdf)

ODH-780 Application for legal assignment of a license to operate an existing Home Care Agency (25k.pdf)

Hospice Licensure Applications and Related Forms:

ODH-924 Application for License to operate a Hospice. Revised 05/2008 (56k.pdf)

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

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:

Oklahoma State Department of Health
PHS-Medical Facilities Service-Home Services Division
1000 NE 10th Street
Oklahoma City, OK 73117-1299
Telephone: 405-271-6576
Email: medicalfacilities@health.ok.gov

Home Health Advisory Board Hospice Advisory Board Licensure Applications and Forms Initial Medicare Certification	OSDH Home > Protective Health > Medical Facilities Service > Home Services Division > Licensure Applications and Forms
	email \| print Home Services Division's Licensure Applications and Forms: Home Care Agency Licensure Applications and Related Forms: ODH-Pending # Initial application to open a Sitter or Companion Service Agency (56k.pdf) ODH-757 New! Revised/Combined Application for License to Operate a Home Care Agency. (Replaces Forms 758, 759, 760 and 776.) ODH-761 Application for a Home Care Agency pro-rated license renewal (24k.pdf) ODH-780 Application for legal assignment of a license to operate an existing Home Care Agency (25k.pdf) Hospice Licensure Applications and Related Forms: ODH-924 Application for License to operate a Hospice. Revised 05/2008 (56k.pdf) ODH-659 Application for Hospice Alternative Administrative Office (50k.pdf) 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: Oklahoma State Department of Health PHS-Medical Facilities Service-Home Services Division 1000 NE 10th Street Oklahoma City, OK 73117-1299 Telephone: 405-271-6576 Email: medicalfacilities@health.ok.gov	Important Note: All applications are processed in the order they are recieved. Q: What is the purpose of the initial licensure on-site survey? A: To determine if your agency meets the minimum requirements to receive a home care license. Failure to comply with all requirements will result in a denial of the application. Your agency must be ready for business at the time of the initial survey. All on-site surveys are pass or fail. All forms, documents, applications, policies, etc. must be complete & available at the time of the survey. >Office of Civil Rights >Link to the Uniform Credentialling Application

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