Change Form for Hospitals

Fees

Credit card payment must be remitted at time of submission.

License Fee Schedule

Bed Increase Change License Fee	$ 10.00/per bed

Change Form Signature

There will only be 1 required signature on the change form.

Floor Plan

Please have a floor plan ready to be uploaded into the change form as this is required with a bed change.

Approval Process

Once you have submitted the change form, it will be sent for approval. Once the change form 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 an updated license if applicable.