Application for Hospitals

Fees

Credit card payment must be remitted at time of submission.

License Fee Schedule

License Fee	$ 10.00/per bed

Application Signature

There will be 2 required signatures on the Application. The administrator of the facility shall not sign the Application unless he/she is also a board member. The Application must be signed by official(s) of the entity responsible for the operation of the facility. (If sole proprietorship, the owner shall sign the Application; if a corporation, two of its officers shall sign; if a state, county, or municipal unit, the Application is to be signed by the head of the department having jurisdiction over the facility.)

Floor Plan

Please have a floor plan ready to be uploaded into the Application as this is required.

Commission on Accreditation of Rehabilitation Facilities (CARF)

North Dakota Administrative Code Section 33-07-01.1-06 requires hospitals submit all accreditation survey results, recommendations, plans of correction, and revisit documentation to our Department.

In addition, Section 33-07-01.1-35 of the North Dakota Administrative Code requires specialized rehabilitation services of a hospital submit all Commission on Accreditation of Rehabilitation Facilities (CARF) survey results, recommendations, and plans of corrections to the Department.

If this is applicable to your hospital, please have it ready to be uploaded into the form as this is required.

Application Approval Process

Once you have submitted the application, it will be sent for approval. Once the application has been reviewed and approved, the contact for the facility will receive an email letting them know it has been approved. The facility may then go to the website and print a license.