AHCA Forms

Health Facilities and Providers

• Be certain to look at our Licensing and Certification page for specific links to applications forms.
• Please use this form to give the Agency feedback regarding your experience with the survey process.

Consumers

• To file a complaint or request a publication, call (888) 419-3456 .
• Get answers to your questions by using our Contact Us form.
• Please use the form below to give the Agency feedback regarding your experience with the complaint process.
  Complaint Process Survey
• AHCA has compiled three types of advance directives: a Living Will, Health Care Surrogate Designation and an Anatomical Donation. The pamphlet provides information to help you decide what will best serve your needs.
• If your facility complaint is related to billing, you can download the form below. Please note, we have no authority to determine how much a facility can charge for any service and cannot intervene in these matters.
  Consumer Billing Complaint Form (62Kb .pdf)

Certificate of Need / Financial Analysis

• The Application and Certificate for Payment, the Project Completion Forecast and the Final Cost Report forms are available for download.
• The CON application packet is available on-line.

Medicaid

• HIPAA Privacy Notice is available.
• Medicaid Newborn Activation Policy is available.
• Medicaid Nursing Facility Provider Information is available.
• Pharmacy Prior Authorization Forms are available.

State Center for Health Statistics

• Limited Data Set Use Agreement Form - This form is required for access to de-identified patient (hospital and/or ambulatory) data.

Health Plans

• "Certification of Health Plan Consumer Report (HPCR-1)" (10Kb. pdf)