Hospital License Application
IMPORTANT: After you click the Download button on this page, you must open the compressed file and save the PDF to your computer, in order to preview and complete the application.
Options for sending the completed initial hospital licensure application:
Option 1
If you wish to submit the completed application electronically and pay by credit card or electronic check, you may go to the Ohio Department of Health's Electronic Forms website. Select the "CertLicensure" tile and then the "Hospital Licensure Application" tile.
Once you have provided basic demographic information and uploaded your completed application, you can then complete your electronic payment.
Option 2
To mail the application, supporting documents, and payment, you must complete the application, print it, and mail it, along with a check payable to "Treasurer, State of Ohio" to:
Ohio Department of Health
Revenue Processing #1241
P.O. Box 15278
Columbus, OH 43215
If you have any questions or require assistance, please contact the Licensing and Certification Unit at:
614-466-7713