Application for Relicensure for Home Health Agency

Renewal Information

The North Dakota Department of Health and Human Services, Health Facilities Unit license expires each annual year on December 31st. Please review the online renewal and correct any inaccurate information, so that our database can be updated with your most current information.

Renewal Form Signature

The person completing the renewal form will be the person to sign on the certification page at the end of the application.

Approval Signatures

Once the renewal form has been submitted, there will be an email that will be sent to both the Administor and Chairman of Governing Body that is listed in the application. The Administor and Chairman of Governing Body will be responsible for either signing the form or forwarding the email to the appropriate person for the signature.

Renewal Approval Process

Once you have submitted the renewal form, it will be sent for approval. Once the renewal form has been reviewed and approved, the contact for the facility will receive an email letting them know it has been approved. The facility may then go to the website and print an updated license. The license will reflect the updated expiration date.