Renewal Reminder Notices are no longer being sent by certified letter. You will now receive a renewal reminder postcard at least 90 days prior to the expiration of your license. To ensure that you receive timely notice, please visit www.FloridaHealthFinder.gov to verify that your mailing address is accurate. See the Frequently Asked Question #2 on this web page for how to make a change of address. Please contact the Home Care Unit by email HQAHOMEHEALTH@ahca.myflorida.com or by phone (850) 412-4403 if you have any questions.
Licensure Application and Related Forms
- Health Care Licensing Application, Hospice, AHCA Recommended Form 3110-4001, Revised August 2011- REQUIRED
- Health Care Licensing Application Addendum, AHCA Recommended Form 3110-1024, August 2010 – REQUIRED
- Proof of Financial Ability to Operate, AHCA Form 3100-0009, July 2009, Schedules 1 – 7, REQUIRED for all initial and change of ownership applications
- Attestation of Compliance with Applicable Life Safety Codes for Additions to Existing Hospice Inpatient Facilities/Residential Units, AHCA Recommended Form, March 2009 - to be submitted with request for bed addition to an existing freestanding hospice inpatient facility or residential unit (Please refer to the Frequently Asked Questions above.)
|NOTE: If after reviewing the application forms and statutory and rule requirements on our web site you have additional questions, please call (850) 412-4403. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you.
Background Screening Information
Emergency Management Planning
- Comprehensive Emergency Management (CEMP) Format for Hospices, DOEA Form H-001, March 2007
- Emergency Management Plan Review
- Requirements for Information and Training on Alzheimer’s Disease and Dementia-Related Disorders – Section 400.6045, Florida Statutes
- All employees, upon beginning employment, must receive basic written information about interacting with persons who have Alzheimer’s disease or dementia-related disorders. Use of The Alzheimer’s Patient and Hospice Care fact sheet developed by Florida Hospice & Palliative Care Association in partnership with the Alzheimer’s Association Chapters of Florida meets this requirement. Association Fact Sheet - (231KB)
- Employees who are expected to, or whose responsibilities require them to, have direct contact with patients with Alzheimer's disease or dementia-related disorders and employees who will be providing direct care to patients with Alzheimer's disease or dementia-related disorders must complete Department of Elder Affairs (DOEA) approved training. For information regarding training requirements, exemptions from and substitutions for training, approval of trainers/curriculum and locating approved training providers, please review the statutes (s. 400.6045, F.S.) and/or the information on the University of South Florida’s Training Academy on Aging (DOEA contractor) website at http://www.trainingonaging.usf.edu/.
- Getting Medicare Certification for a Hospice
- List of licensed providers - www.FloridaHealthFinder.gov
Bureau of Long Term Care Services
Home Care Unit
2727 Mahan Drive - Mail Stop #34
Tallahassee, FL 32308
(850) 412-4403 Phone
(850) 922-5374 Fax