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Home Services Division's Licensure Applications and Forms:


Application Guidance Letters:

Home Care Application Guidance

Home Care Renewal Letter

Home Care Change of Ownership (CHOW) Guidance

Companion Sitter Application Guidance

Hospice Application Guidance

Hospice Renewal Letter

Hospice Change of Ownership Guidance


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 & Medicaid Services) Forms:

CMS Forms for Home Health 2017

CMS Forms for Hospice 2017

Contact Us: 

OSDH - Medical Facilities Service
Attn:
Home Services Division
1000 NE 10th Street
Oklahoma City, OK 73117-1299

Telephone: 405-271-6576
Fax: 405-271-1141

Email: medicalfacilities@health.ok.gov

 


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.

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