AHCA: Forms

AHCA Forms

Health Facilities and Providers

Be certain to look at our Licensing and Certification page for specific links to applications forms.
Please complete this survey to give the Agency feedback regarding your experience with the survey process.
Licensure Application Forms by Provider Type

Consumers

To file a complaint about a health care facility, such as a hospital, nursing home, assisted living facility, home health agency, or other type of health care facility, call (888) 419-3456. Complaints may also be filed by clicking here to complete the Health Care Facility Complaint Form. Please click this link to search our FloridaHealthFinder.gov site to see if the facility you have concerns about is one that is regulated by our Agency.
To request an Agency publication, call (888) 419-3456, or click Publications.
Get answers to your questions by using our Contact Us form.
Please complete the Complaint Process Survey to give the Agency feedback regarding your experience with the complaint process.
AHCA has compiled three types of advance directives: a Living Will, Health Care Surrogate Designation and an Anatomical Donation. The pamphlet provides information to help you decide what will best serve your needs.
If your facility complaint is related to billing, you can download the form below. Please note, we have no authority to determine how much a facility can charge for any service and cannot intervene in these matters.
Consumer Billing Complaint Form (62Kb .pdf)

Certificate of Need / Financial Analysis

The Application and Certificate for Payment, the Project Completion Forecast and the Final Cost Report forms are available for download.
The CON application packet is available on-line.

Medicaid

Florida Center for Health Information and Policy Analysis

Limited Data Set Use Agreement Form - This form is required for access to de-identified patient (hospital and/or ambulatory) data.

Health Plans