1. (1) Applicants must apply for licensure or exemption using the program specific forms incorporated below and the Health Care Licensing Application Addendum, AHCA Form 3110-1024, August 2023, available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16384"http://www.flrules.org/Gateway/reference.asp?No=Ref-16384. All forms are incorporated by reference and available at: https://ahca.myflorida.com/health-care-policy-and-oversight/hcpo-applications-for-licensure and online through the Agency’s Online Portal at: http://apps.ahca.myflorida.com/SingleSignOnPortal. For online submissions, the information required on the Health Care Licensing Application Addendum is incorporated into the program specific online licensure application forms.
2. (2) Renewal applicants must apply online by submitting the online licensure application form, fees, and supporting documents electronically through the Agency’s Online Portal. Hard copy application forms are not accepted for the purpose of licensure renewal. Renewal applications submitted on hard copy forms will be returned to the applicant unprocessed.

3. (3) Application forms to be used for licensure.

   1. (a) Abortion Clinic, as provided under Chapter 390, F.S.

      1. Health Care Licensing Application Abortion Clinic, AHCA Form 3130-1000, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16385"http://www.flrules.org/Gateway/reference.asp?No=Ref-16385; or

      2. Health Care Licensing Online Application Abortion Clinic, AHCA Form 3130-1000OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16386"http://www.flrules.org/Gateway/reference.asp?No=Ref-16386.

   2. (b) Adult Day Care Center, as provided under Chapter 429, Part III, F.S.

      1. Health Care Licensing Application Adult Day Care Center, AHCA Form 3180-1004, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16387"http://www.flrules.org/Gateway/reference.asp?No=Ref-16387; or

      2. Health Care Licensing Online Application Adult Day Care Center, AHCA Form 3180-1004OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16388"http://www.flrules.org/Gateway/reference.asp?No=Ref-16388.

   3. (c) Adult Family-Care Home, as provided under Chapter 429, Part II, F.S.

      1. Health Care Licensing Application Adult Family-Care Home, AHCA Form 3180-1022, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16389"http://www.flrules.org/Gateway/reference.asp?No=Ref-16389; or

      2. Health Care Licensing Online Application Adult Family-Care Home, AHCA Form 3180-1022OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16390"http://www.flrules.org/Gateway/reference.asp?No=Ref-16390.

   4. (d) Ambulatory Surgical Center, as provided in 395 Part I, F.S.

      1. Health Care Licensing Application Ambulatory Surgical Center, AHCA Form 3130-2001, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16391"http://www.flrules.org/Gateway/reference.asp?No=Ref-16391; or

      2. Health Care Licensing Online Application Ambulatory Surgical Center, AHCA Form 3130-2001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16392"http://www.flrules.org/Gateway/reference.asp?No=Ref-16392.

   5. (e) Assisted Living Facility, as provided in 429 Part I, F.S.

      1. Health Care Licensing Application Assisted Living Facilities, AHCA Form 3110-1008, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16393"http://www.flrules.org/Gateway/reference.asp?No=Ref-16393; or

      2. Health Care Licensing Online Application Assisted Living Facilities, AHCA Form 3110-1008OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16394"http://www.flrules.org/Gateway/reference.asp?No=Ref-16394.

   6. (f) Birth Center, as provided under Chapters 383.30 – 383.335, F.S.

      1. Health Care Licensing Application Birth Center, AHCA Form 3130-3001, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16395"http://www.flrules.org/Gateway/reference.asp?No=Ref-16395; or

      2. Health Care Licensing Online Application Birth Center, AHCA Form 3130-3001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16396"http://www.flrules.org/Gateway/reference.asp?No=Ref-16396.

   7. (g) Crisis Stabilization Unit or Short-Term Residential Treatment Facility, as provided under Parts I and IV of Chapter 394, F.S.

      1. Health Care Licensing Application Crisis Stabilization Unit or Short-Term Residential Treatment Facility, AHCA Form 3180-5003, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16397"http://www.flrules.org/Gateway/reference.asp?No=Ref-16397; or

      2. Health Care Licensing Online Application Crisis Stabilization Unit or Short-Term Residential Treatment Facility, AHCA Form 3180-5003OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16398"http://www.flrules.org/Gateway/reference.asp?No=Ref-16398.

   8. (h) Forensic Toxicology Laboratory (also known as Drug Free Workplace Laboratory), as provided under Chapter 112, Part I and 440.102, F.S.

      1. Health Care Licensing Application Forensic Toxicology Laboratory, AHCA Form 3170-5001, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16399"http://www.flrules.org/Gateway/reference.asp?No=Ref-16399; or

      2. Health Care Licensing Online Application Forensic Toxicology Laboratory, AHCA Form 3170-5001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16400"http://www.flrules.org/Gateway/reference.asp?No=Ref-16400.

   9. (i) Health Care Clinic, as provided under Chapter 400, Part X, F.S.

      1. Health Care Licensing Application Health Care Clinic, AHCA Form 3110-0013, August 2023 incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16401"http://www.flrules.org/Gateway/reference.asp?No=Ref-16401; or

      2. Health Care Licensing Online Application Form Health Care Clinic, AHCA Form 3110-0013OL, August 2023 incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16402"http://www.flrules.org/Gateway/reference.asp?No=Ref-16402.

   10. (j) Health Care Services Pool, as provided under Chapter 400, Part IX, F.S.

       1. Health Care Licensing Application Health Care Services Pool, AHCA Form 3110-1010, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16403"http://www.flrules.org/Gateway/reference.asp?No=Ref-16403; or

       2. Health Care Licensing Online Application Health Care Services Pool, AHCA Form 3110-1010OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16404"http://www.flrules.org/Gateway/reference.asp?No=Ref-16404.

   11. (k) Home Health Agency, as provided under Chapter 400 Part III, F.S.

       1. Health Care Licensing Application Home Health Agencies, AHCA Form 3110-1011, July 2024, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-17848"http://www.flrules.org/Gateway/reference.asp?No=Ref-17848; or

       2. Health Care Licensing Online Application Home Health Agencies, AHCA Form 3110-1011OL, July 2024, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-17847"http://www.flrules.org/Gateway/reference.asp?No=Ref-17847.

   12. (l) Home Medical Equipment Provider, as provided under Chapter 400, Part VII, F.S.

       1. Health Care Licensing Application Home Medical Equipment Provider AHCA Form 3110-1005, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16407"http://www.flrules.org/Gateway/reference.asp?No=Ref-16407; or

       2. Health Care Licensing Online Application Home Medical Equipment Provider AHCA Form 3110-1005OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16408"http://www.flrules.org/Gateway/reference.asp?No=Ref-16408.

   13. (m) Homemaker and Companion Services Provider, as provided under Chapter 400, Part III, F.S.

       1. Health Care Licensing Application Homemaker and Companion Services Provider, AHCA Form 3110-1003, July 2024, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-17849"http://www.flrules.org/Gateway/reference.asp?No=Ref-17849; or

       2. Health Care Licensing Online Application Homemaker and Companion Services Provider, AHCA Form 3110-1003OL, August 2023, incorporated by reference incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16410"http://www.flrules.org/Gateway/reference.asp?No=Ref-16410.

   14. (n) Hospice, as provided under Chapter 400, Part IV, F.S.

       1. Health Care Licensing Application Hospice, AHCA Form 3110-4001, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16411"http://www.flrules.org/Gateway/reference.asp?No=Ref-16411; or

       2. Health Care Licensing Online Application Hospice, AHCA Form 3110-4001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16412"http://www.flrules.org/Gateway/reference.asp?No=Ref-16412.

   15. (o) Hospital, as provided under Chapter 395, Part I, F.S.

       1. Health Care Licensing Application Hospitals, AHCA Form 3130-8001, July 2024, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-17813"http://www.flrules.org/Gateway/reference.asp?No=Ref-17813; or

       2. Health Care Licensing Online Application Hospitals AHCA Form 3130-8001OL, July 2024, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-17815"http://www.flrules.org/Gateway/reference.asp?No=Ref-17815.

   16. (p) Intermediate Care Facilities for the Developmentally Disabled, as provided under Chapter 400, Part VIII and Chapter 393, F.S.

       1. Health Care Licensing Application Intermediate Care Facilities for the Developmentally Disabled, AHCA Form 3110-5003, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16415"http://www.flrules.org/Gateway/reference.asp?No=Ref-16415; or

       2. Health Care Licensing Online Application Intermediate Care Facilities for the Developmentally Disabled, AHCA Form 3110-5003OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16416"http://www.flrules.org/Gateway/reference.asp?No=Ref-16416.

   17. (q) Nurse Registry, as provided under 400.506, F.S.

       1. Health Care Licensing Application Nurse Registry, AHCA Form 3110-7004, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16417"http://www.flrules.org/Gateway/reference.asp?No=Ref-16417; or

       2. Health Care Licensing Online Application Nurse Registry, AHCA Form 3110-7004OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16418"http://www.flrules.org/Gateway/reference.asp?No=Ref-16418.

   18. (r) Nursing Home, as provided under Chapter 400, Part II, F.S.

       1. Health Care Licensing Application Nursing Home, AHCA Form 3110-6001, August 2023 incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16419"http://www.flrules.org/Gateway/reference.asp?No=Ref-16419; or

       2. Health Care Licensing Online Application Nursing Home, AHCA Form 3110-6001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16420"http://www.flrules.org/Gateway/reference.asp?No=Ref-16420.

   19. (s) Organ Procurement Organization, Tissue Bank, or Eye Bank, as provided under Chapter 765, Part V, F.S.

       1. Health Care Licensing Application Organ Procurement Organization, Tissue Bank, Eye Bank, AHCA Form 3140-2001, August 2023 incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16421"http://www.flrules.org/Gateway/reference.asp?No=Ref-16421; or

       2. Health Care Licensing Online Application Organ Procurement Organization, Tissue Bank, Eye Bank, AHCA Form 3140-2001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16422"http://www.flrules.org/Gateway/reference.asp?No=Ref-16422.

   20. (t) Prescribed Pediatric Extended Care Center, as provided under Chapter 400, Part VI, F.S.

       1. Health Care Licensing Application Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16423"http://www.flrules.org/Gateway/reference.asp?No=Ref-16423; or

       2. Health Care Licensing Online Application Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16424"http://www.flrules.org/Gateway/reference.asp?No=Ref-16424.

   21. (u) Residential Treatment Center for Children and Adolescents, as provided under Chapter 394, Part IV, F.S.

       1. Health Care Licensing Application Residential Treatment Center for Children and Adolescents, AHCA Form 3180-5004, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16425"http://www.flrules.org/Gateway/reference.asp?No=Ref-16425; or

       2. Health Care Licensing Online Application Residential Treatment Center for Children and Adolescents, AHCA Form 3180-5004OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16426"http://www.flrules.org/Gateway/reference.asp?No=Ref-16426.

   22. (v) Residential Treatment Facility, as provided under Chapter 394, Part IV, F.S.

       1. Health Care Licensing Application Residential Treatment Facility, AHCA Form 3180-5005, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16427"http://www.flrules.org/Gateway/reference.asp?No=Ref-16427; or

       2. Health Care Licensing Online Application Residential Treatment Facility, AHCA Form 3180-5005OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16428"http://www.flrules.org/Gateway/reference.asp?No=Ref-16428.

   23. (w) Transitional Living Facility, as provided under Chapter 400, Part XI

       1. Health Care Licensing Application Transitional Living Facility, AHCA Form 3110-9001, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16429"http://www.flrules.org/Gateway/reference.asp?No=Ref-16429; or

       2. Health Care Licensing Online Application Transitional Living Facility, AHCA Form 3110-9001OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16430"http://www.flrules.org/Gateway/reference.asp?No=Ref-16430.

4. (4) Application forms to be used to apply for certificates of exemption from licensure.

   1. (a) Health Care Clinic Exemption from Licensure, as provided under Chapter 400, Part X, F.S.

      1. Application for Certificate of Exemption from Licensure as a Health Care Clinic, AHCA From 3110-0014, August 2023 incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16431"http://www.flrules.org/Gateway/reference.asp?No=Ref-16431; or

      2. Online Application for Certificate of Exemption from Licensure as a Health Care Clinic, AHCA Form 3110-0014OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16432"http://www.flrules.org/Gateway/reference.asp?No=Ref-16432.

   2. (b) Home Health Agency Exemption from Licensure, as provided under Chapter 400 Part III, F.S.

      1. Application for Certificate of Exemption from Licensure as a Home Health Agency, AHCA Form 3110-1009, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16433"http://www.flrules.org/Gateway/reference.asp?No=Ref-16433; or

      2. Online Application for Certificate of Exemption from Licensure as a Home Health Agency, AHCA Form 3110-1009OL, August 2023, incorporated by reference at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16434"http://www.flrules.org/Gateway/reference.asp?No=Ref-16434.

5. (5) All required fees must be included with the application. Applications will be returned to the applicant unprocessed if required fees are not submitted with the application. Applications from state agencies must include a copy of the posted journal transactions by State Wide Document Number (SWDN) within benefiting Operating Level Organization (OLO) and site.
6. (6) Applications received more than 120 days prior to the date of license expiration or the effective date will be returned to the applicant unprocessed.
7. (7) If an applicant, licensee, or controlling interest is required to register or file with the Florida Secretary of State, Division of Corporations, the principal, fictitious name and mailing addresses submitted with the licensure application for the applicant, licensee and controlling interests must be the same as the information registered with the Division of Corporations.
8. (8) Unresponsive applicant. If certified mail sent to the provider’s address of record, or mailing address if applicable, is returned as unclaimed or undeliverable, the Agency will send a copy of the letter by regular mail to the provider’s address of record, or mailing address if applicable, with a copy to the applicant’s address if different from the provider. The applicant must respond to the request within 21 days of the date of the letter sent by regular mail. If timely response is not received, the application will be subject to withdrawal or denial.

9. (9) An application is considered complete upon receipt of:

   1. (a) All required documents, information and required fees;
   2. (b) All required background screening results; and,
   3. (c) Completion of a satisfactory inspection if required by authorizing statutes or rules. Satisfactory inspection means no regulatory violations exist, or all prior violations found have been determined by the Agency to be corrected.
10. (10) A licensure inspection will not be authorized until sections (9)(a) and (b) of this rule have been satisfied.
11. (11) An application for license renewal may only be filed online by the licensee.

Rulemaking Authority 112.0455, 383.305, 390.0111, 390.012, 394.877, 395.004, 395.1055, 400.23, 400.497, 400.509, 400.605, 400.801, 400.914, 400.935, 400.967, 400.980, 400.9925, 400.9982, 408.819, 408.822, 429.41, 429.67, 429.73, 429.929, 765.541, FS. Law Implemented 112.0455, 383.305, 390.014, 390.015, 394.876, 394.877, 395.004, 395.0161, 400.062, 400.071, 400.464, 400.471, 400.506, 400.509, 400.606, 400.801, 400.905, 400.906, 400.931, 400.962, 400.980, 400.991, 400.9925, 400.9935, 400.9972, 400.801, 408.805, 408.806, 408.809, 408.810, 408.811, 408.822, 429.07, 429.11, 429.17, 429.67, 429.909, 765.544, FS. History–New 7-14-10, Amended 5-4-15, 3-5-24, 6-5-25.