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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.
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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 |
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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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