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