To be considered for a license to provide skilled home health services as a home health agency or nonagency provider, you must submit a completed application and a non-refundable application fee of $250.00.

Option 1 – Electronic (fastest)

If you wish to complete the form electronically and pay by credit card or electronic check, you can go to the below web link and select the “CertLicensure” option.

Home Health Electronic Application

You will then need to choose the appropriate application. Once you have completed the application, you will then be able to complete the electronic payment.

Option 2 – Mail

To mail the application, supporting documents and payment; you will need to select the “download” option, complete the form, print it and mail all it to:

Ohio Department of Health

Revenue Processing #3506

P.O. Box 15278

Columbus OH. 43215

Surety Bond

Skilled Home Health Services Surety Bond Form in the amount of $50,000.