State Licensure Forms


These pages provide downloadable PDFs for state licensure, and related forms, and instructions for health care providers regulated by the Health Facilities Program. Additionally, the pages provide links to Medicare certification forms and related information which may be applicable to health care providers seeking Medicare reimbursement:

Visit the Centers for Medicare and Medicaid Services website (formerly Health Care Financing Administration) to find specific provider/supplier enrollment forms; associated information can be found on these pages.

Please consult appropriate state laws and state regulations as well as federal laws and federal regulations for definitions and other requirements for the provider types discussed on this page. Questions about state licensure/Medicare certification forms for KDHE regulated providers can be directed to the Hospital and Medical Program at 785-296-0127.