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Last Updated: 02/01/12 12:29:20 PM

 HCQC Forms

Most forms are downloadable in Microsoft Word (word) or Adobe Acrobat (pdf) file formats. Download and save the file to your computer, complete the form, and mail to the Bureau of Health Care Quality and Compliance at the address indicated on the form.

 

Child Care Facility Forms
 

Health Facilities 

 

Application for Medical Facilities, Health Facilities, and other provider types (pdf)

**This is a general application appropriate for all types of facility licensure such as initial licensure, change of ownership, change of name, endorsement addition, change of administrator, change of category, change of location, bed increase or decrease, etc. Please complete the first three pages and any other applicable forms depending on the type of license you are applying for.  *This licensure application is not for Outpatient Facilities (office based surgery). Please see the permit application below.

** It is critical that you review the Nevada Revised Statutes (NRS) chapter 449 Medical and Other Related Facilities before you apply for licensure. The statutes can be found at
http://www.leg.state.nv.us/NRS/NRS-449.html. The statutes, or laws found in this chapter pertain to our licensed facilities.

** It is also critical that you review the Nevada Administrative Codes (NAC) chapter 449 Medical and Other Related Facilities before you apply for licensure. The codes or regulations can be found at
http://www.leg.state.nv.us/NAC/NAC-449.html.  Please review the sections titled, “General Provisions, General Requirements for Licensure, Fees and Administrative Sanctions. Those codes or regulations apply to all of our licensed facilities. Then review the section of regulations that pertain specifically to the facility type you are applying for. Facility specific regulations provide important definitions and regulations concerning the operation of each facility type.

** Checklist for any Medical or Health Facility wanting to submit an initial or change of ownership application - Choose the checklist below for your facility type to view the documents that you must submit with your initial or change of ownership application packet.

 

 

ADA   ADC   AGC   ASC   BPR   CTC   ESR   HFS   HHA   HIC   HOS   HPC   HWH   ICE   ICF   IMR   LSK   MBU   MDX   NSP   NTC  OBC   PCA   RHC   SNF   TLF

 

** Checklist for any Medical or Health Facility wanting to make a change to an existing license (pdf)
 

Regardless of the type of application you are submitting, ALL of the documents listed on a checklist MUST be submitted with the application packet.  If any of the documents are missing from the packet, your application packet will be returned to you.

 

** Once your application packet is complete with all of the required documents, the packet will be processed and then forwarded to a supervisor who will either approve the application or schedule an inspection depending on the application type.  If the application does not require an inspection, you will receive a printed license in the mail.  If the application requires an inspection, you might or might not be contacted by an inspector prior to the inspection depending on the application type.  After the inspection, when you are found to be in full compliance with all the applicable regulations, a supervisor will approve the application and you will receive a printed license in the mail.
 

Outpatient Facilities (office based surgery)

·         Permit Application for Outpatient Facilities (pdf)

OPF

Miscellaneous applications, forms and other licensure information

Plan Review Documents

·         Plan Review Application and Instructions (word) (pdf)

·         Functional Plan Instructions

o    Ambulatory Surgical Center (word) (pdf)

o     Hospital (word) (pdf)

o     Psychiatric Hospital (word) (pdf)

o     Rehabilitation Hospital (word) (pdf)

o     Skilled Nursing Facility (word) (pdf)

·         Plan Review of Food Establishments within Health Facilities (word) (pdf)

Plan Review and Permitting of Swimming Pools and Spas within Health Facilities Instruction Page (word) (pdf)

Medical Laboratories and Personnel Downloadable Applications

Labs

Personnel

Music Therapy Forms

Radiological Health Forms

 
facility services

 

Individual Health Facilities Inspection and Survey Results Search
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Inspection Reports

 

For information on recent surveys, please contact us at (775) 684-1030.

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Workshops

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Nevada State Health Division
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