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Oregon HCLC Forms
The following forms are available to download. If you need any of these documents in large print, please advise Oregon Health Care Licensure and Certification at:
Phone: 971-673-0540
Fax: 971-673-0556
TTY: 971-673-0372
All files are in Adobe format. You can download the free Adobe viewer here.
| ATTENTION: Please be advised that on January 1, 2010 new fee schedules will be in affect. Most fees have been increased. Any application received after December 31, 2009 will need to pay the new fee. |
General HCLC Forms
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| AMBULATORY SURGICAL CENTERS - License Application Form |
70K
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| BIRTHING CENTERS - License Application Form |
70K
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| OUTPATIENT RENAL DIALYSIS FACILITY - License Application Form |
69K
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HOME HEALTH AGENCY -License Application/Renewal Form |
114K
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HOSPITAL RESPITE CARE SERVICES - Approval Form
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21K
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| HOSPITAL LICENSE APPLICATION FORM |
81K
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| IN-HOME CARE AGENCY - Initial/Renewal License Application |
54K
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SPECIAL INPATIENT CARE FACILITY - APPLICATION FORM
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74K
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INITIAL COMPLAINT INTAKE FORM
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40K
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| Hemodialysis Application and Forms |
Hemodialysis Only
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| Hemodialysis Technician - Certification Application |
45K
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| Hemodialysis Technician - Certification Application - RENEWAL only |
47K
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| Hemodialysis Technician - Provisional Certification Application |
44K
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| Hemodialysis Technician - Provisional Certification Application - RENEWAL only |
42K
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| Hemodialysis Technician - Fee Schedule |
10K |
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