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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


$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.

Special Announcements
All 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 application.

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