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Last Updated: 09/15/14 05:04:22 PM

 HCQC Forms & Applications

 When registering your business on-line with SilverFlume
please ensure that you complete the Common Business Registration (CBR).
 

INITIAL STEPS FOR HEALTH FACILITIES LICENSURE, CERTIFICATES OR PERMITS

Step 1:  All businesses must have an active State Business License or Certificate of Exemption. 

State law requires that every person or entity doing business in the State of Nevada obtain a State Business License or Certificate of Exemption. If you are starting a business, such as a medical facility or residential care facility, please start your business at SilverFlume Nevada's Business Portal at www.nvsilverflume.gov. 

When registering your business on-line with SilverFlume please ensure that you complete the Common Business Registration (CBR).

For more information on SilverFlume (Nevada’s Business Portal) go to:

Step 2: Prepare your health facilities licensure, certificate, or permit application(s).

After completing Step 1 return to this webpage and ensure you complete the Application for Medical Facilities, Health Facilities and other provider types form, appropriate child care facility form, medical laboratories form or Permit Application for Outpatient Facilities form, as applicable AND submit with your application all of the required documents found on the checklist for your facility type, as applicable.  All forms, applicable checklists or links to forms can be found by returning to this webpage.  

 
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.

Health Facilities 

 

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

Facility Incident Self-Report Form (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 - Facility for the treatment of abuse of alcohol or drugs

ADC - Facility for the care of adults during the day

AGC - Residential facility for groups (adult group care/assisted living)

ASC - Surgical center for ambulatory patients

BPR - Businesses that provide referrals to residential facility for groups

CTC - Community triage center

ESR - Facility for the treatment of irreversible renal disease (dialysis center)

HFS - Facility for hospice care

HHA - Home health agency

HIC - Home for individual residential care

HOS - Hospital

HPC - Hospice agency

HWH - Halfway house for recovering alcohol and drug abusers

ICE - Independent centers for emergency medical care

ICF - Facility for intermediate care
ISO - Intermediary Service Organization

IMR - Intermediate care facilities for mental retardation or developmental disabilities

LSK - Facility for refractive surgery

MBU - Mobile unit

MDX - Facility for modified medical detoxification

NSP -  Nursing pool

NTC - Facility for treatment with narcotics (methadone clinic)

OBC - Obstetric center

PCA - Agency to provide personal care services in the home (personal care agency)

RHC - Rural clinic

SNF - Facility for skilled nursing

TLF - Facility for transitional living for released offenders

 

 

** 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 using IV conscious sedation)

·         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) med

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

 
Child Care Licensing Forms
 
facility services

Inspection Reports
Individual Health Facilities Inspection and Survey Results Search

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

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