Phase I of the online application portal for its licensing programs has launched for applications for:
- New licenses
- Renewal of existing licenses
- Exemptions (for hospices and HCOs)
- Changes to existing licenses
Please use the VDH OLC Portal button to access the new system. Instructions for how to request a user access account are hyperlinked beneath the VDH OLC Portal button
Certificate of Public Need
Application Forms
COPN Long Term Care Forms
- Instructions
- Estimated Costs
- Facility Staffing
- Revenue/Expense Statement
- Tabulation of Space
- Bed Complement
Other Forms
Home Care
Application Forms
Use the VDH OLC Portal to:
- Apply for a new license
- Renew an existing license
- Request an exemption
- Report changes to your licensing record (e.g., change of name, location, etc.)
Other Forms
Hospice
Application Forms
Use the VDH OLC Portal to:
- Apply for a new license
- Renew an existing license
- Request an exemption
- Report changes to your licensing record (e.g., change of name, location, etc.)
Other Forms
Hospital
Application Forms
Use the VDH OLC Portal to:
- Apply for a new license
- Renew an existing license
- Report changes to your licensing record (e.g., change of name, location, etc.)
Other Forms
- Facility Reported Incident Form
- Acute Care Facility Response Form
- Model Universal Transfer Form
- Model Universal Transfer Summary
- Request for Disaster Exemption
- Notification of Utilization of Disaster Exemption
Other Resources
- Checklist - Adult Sexual Assault Survivor Transfer Plan
- Checklist - Adult Sexual Assault Survivor Treatment Plan
- Checklist - Pediatric Sexual Assault Survivor Treatment Plan (partial range of treatment services offered to pediatric patients)
- Checklist - Pediatric Sexual Assault Survivor Treatment Plan (full range of treatment services offered to pediatric patients)
- Checklist - Pediatric Sexual Assault Survivor Transfer Plan
Managed Care Health Insurance Plan and Private Review Agent
Nursing Home
Application Forms
- Use the VDH OLC Portal to:
- Apply for a new license
- Renew an existing license
- Report changes to your licensing record (e.g., change of name, location, etc.)
- e-Plan of Correction (ePOC) Application Information
- Application for Feeding Hydration Program
Other Forms
- Bed Change Form
- LTC Facility Survey Response Form
- Facility Reported Incident Form
- Informal Dispute Resolution (IDR) Process
- Independent-IDR-Process
- Extended Care Facility Response Guideline
- Model Universal Transfer Form
- Model Universal Transfer Summary
- Payroll Based Journal System
- Public Directory [updated 7/2021]
- Request for Disaster Exemption
- Notification of Utilization of Disaster Exemption
Click below to access application portal
NOTE: This portal is for licensing only. Applicants for COPN, MCHIP, and PRA should continue to use the applications linked on this page and pay via check or money order.
- If you are a new user WITHOUT A LICENSE, please follow these "Requesting User Access as an Applicant for Licensure" instructions to request a user access account.
- If you have a license and only have one licensed facility/agency, please follow these "Requesting User Access as an Existing Licensee" instructions to request a user access account.
- If you have a license and have multiple licensed facilities/agencies, please follow these "Requesting User Access for Multiple Facilities/Agencies" instructions to request a user access account.
- If you are a returning user (i.e., you already have a user access account), click the button above and select "Login" in the upper right hand corner of the portal, then login in with your username and password.