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Home Services Division's Licensure Applications and Forms:


Application Guidance Letters:

Companion Sitter Application Guidance

Home Services Change of Information (CHOI) Guidance

Home Care Application Guidance

Home Care Change of Ownership (CHOW) Guidance

Hospice Application Guidance

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 License to Operate a Home Care Agency Branch. (33.29k.pdf)

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 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 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.


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