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Attention

HOME HEALTH AGENCIES

    • Address Requirements:

    Initial applicants for licensure must submit: (1) proof of legal right to occupy the property (per section 408.810(6), Florida Statutes) -- proof may include copies of a lease, rental agreement, warranty deeds or contracts for deed and (2) INITIAL applicants must also include evidence of zoning which includes either a certificate of use, certificate of occupancy or a letter from the zoning department stating that the location is zoned appropriately as a home health agency

    Change in Address: Notify the AHCA Licensed Home Health Programs Unit 14 days in advance of an address change, including changes in suite numbers. Zoning documentation & evidence of legal right to property, as described above, must be submitted. There is a $500 fine if AHCA does not receive the notification of a change in address 14 days in advance of the change.

    • Personnel Changes

    Home health agencies must notify the AHCA Licensed Home Health Programs Unit of any changes in the administrator or alternate administrator prior to or on the date of change (Section 59A-8.0095(1)(b) Florida Administrative Code).

    For the Administrator send:

        • A resume
        • A fingerprint card or proof of level 2 background screening. Proof of prior screening can only be accepted if (1) it is less than 5 years old and (2) it was done by AHCA, the Department of Children and Families, the Department of Health, or the Agency for Persons with Disabilities
        • A notarized Affidavit of Compliance with Background Screening, AHCA Form 3100-0008, November 2006 (see form above under the Initial Licensure Application or below under the Renewal Licensure Application)

    For the Alternate Administrator send:

        • A resume
        • A notarized Affidavit of Good Moral Character, AHCA Form 3110-0001, December 2006 (see “Affidavit of Good Moral Character to be signed by Staff” below)

Attention

HOSPICES

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.

 

Attention

NURSE REGISTRIES

 

  • 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

Attention

HOMEMAKER, COMPANION SERVICES

NOTE: If after reviewing the application forms, Frequently Asked Questions, and Florida Statutes you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions, 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 items missing from your application once receivedsend you a letter that gives you another chance to complete the application successfully. If you need help in filling out the application forms, we would advise you to seek help from an attorney or a consultant.

List of registered providers - www.FloridaHealthFinder.gov

Attention

HOME MEDICAL EQUIPMENT (HME) PROVIDERS

 

 

Attention

HEALTH CARE SERVICES POOLS

NOTE: If after reviewing the application forms, Frequently Asked Questions, Florida Statutes, and State Rules you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions, 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 items missing from your application once receivedsend you a letter that gives you another chance to complete the application successfully. If you need help in filling out the application forms, we would advise you to seek help from an attorney or a consultant.