Bureau of Health Facility Regulation
Home Care Unit
2727 Mahan Drive - Mail Stop #34
Tallahassee, FL 32308
(850) 414-6010 Phone
(850) 922-5374 Fax

email: HQAHOMEHEALTH@ahca.myflorida.com

NURSE REGISTRIES

• Frequently Asked Questions
• Regulatory Update Presentation, including changes in state law effective July 1, 2009
• Florida Statutes
  • Chapter 400, Part III, F.S.
  • Memo on 2009 law changes
  • 2009 law changes effective 7-1-09 - SB 1986, Chapter 2009-223
  • Chapter 408, Part II, Florida Statues (health care licensing procedures)
• State Rules - Florida Administrative Code, Chapter 59A-18
• State Regulation Set used by surveyors
• Initial Licensure Application and Forms
  • Initial Application Instructions
  • Initial Application for License AHCA Form 3110-7001
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • Affidavit of Compliance with Screening, AHCA Form 3110-1014
  • Affidavit to be submitted if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)

   

  NOTE: If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you.

• Notice to all Licensed Nurse Registries
  • Nurse Registries undergoing a change of ownership should use the Initial Application AHCA Form 3110-7001. In addition to the required forms, a change of ownership application must also include the bill of sale, if available, and a copy of a signed and dated asset purchase agreement indicating that a change of ownership is pending.

Nurse Registries changing their address must send in a letter notifiying the Agency of the effective date of the move and include evidence of compliance with local zoning (a letter or form from the local zoning authorities) and have a fire inspection completed.

• Renewal Licensure Application and Forms

• Renewal Application Instructions
• Renewal Application for License AHCA Form 3110-7004
• Health Care Licensing Application
• Health Care Licensing Addendum
• Affidavit of Compliance with Screening, AHCA Form 3110-1014
• Affidavit to be submitted if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)
• Background Screening information
• Emergency Management Plan
  • Emergency Management Plan Format
  • Memo sent to Nurse Registries on 2006 law changes
  • Emergency Management Plan Review Contacts
• List of licensed agencies - www.FloridaHealthFinder.gov

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