Division of Health Facilities Evaluation and Licensing

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Forms

To access a category of following forms, click the corresponding link below.

Publications

Revised Fee Schedule for CN Applications as of July 1, 2003 (pdf 7k)

Long Term Acute Care Services Bed Need (pdf 65k)

Fees for the Licensure and Biennial Inspection of Acute Care Facilities (pdf 13k) (4/19/2004)

To review Provider Enrollment Procedures, click the appropriate Provider type:

Translated Banking and Insurance, HIPAA and NJ Health Care Forms 

The sample health care forms on this page have been translated into four languages: Haitian Creole, Mandarin Chinese, Hindi and Spanish. The forms are offered free of charge to facilitate communication between patients and health care workers, and to reduce disparities.

 


Health Facilities Licensure Payments

Submit Payments for Health Facilities Licensure


Nursing Home Administrator Licensing Board Payments

Submit Payments for Nursing Home Administrator Licensing Board