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Health Care Facility (HCF) - Apply by mail
 

Apply by Mail

Use the following chart as a guideline when applying, renewing or amending a license.

  Initial Application Renewal Application Amendment Application
Fill out necessary forms HEA5134 Renewal Application Mailed to facility HEA5135
Application Fee $300 $300 $150 (when applicable)
Fire and Inspection Report (within last 12 months) X X (address change or building renovation only)

Use and Occupancy Report
X   (address change or building renovation only)
Notarized Affidavit (required when someone other than an owner signs application) X X X
Renewal Notice mailed to you.   X  

Mail to:
Ohio Department of Health
Health Care Facility Program
Attn: Revenue Processing - 3600
P.O. Box 15278
Columbus, OH 43215

Telephone: (614) 644-2727