Online forms are available from various sections of the Division of Health Service Regulation.

Acute and Home Care Licensure and Certification Section

Adult Care Licensure Section

Complaint Intake Unit

Health Care Personnel Registry Section

Jails and Detention Section

Medical Facilities Planning Section

Mental Health Licensure and Certification Section

N.C. Medical Care Commission

Continuing Care Retirement Center (CCRC) Forms:

  1. Construction Application -- PDF (60 KB) | Microsoft Word (DOC, 72 KB)
  2. Equipment Application -- PDF (32 KB) | Microsoft Word (DOC, 64 KB)
  3. Request For Disbursement -- PDF (28 KB) | Microsoft Word (DOC, 36 KB)
  4. Community Benefit GS105 Form -- PDF (36 KB) | Microsoft Word (DOC, 64 KB)
  5. HFA Project Funds Status Report Master -- PDF (8 KB) | Microsoft Excel (XLS, 20 KB)
  6. Community Benefits Form of Agreement and Program Description -- PDF (92 KB) | Microsoft Word (DOC, 52 KB)

Hospital Forms:

  1. Construction Application -- PDF (56 KB) | Microsoft Word (DOC, 108 KB)
  2. Equipment Application -- PDF (32 KB) | Microsoft Word (DOC, 60 KB)
  3. Community Benefits (ANDI) ** -- PDF (36 KB) | Microsoft Word (DOC, 48 KB)
  4. Request For Disbursement -- PDF (28 KB) | Microsoft Word (DOC, 36 KB)
  5. HFA Project Funds Status Report Master -- PDF (8 KB) | Microsoft Excel (XLS, 20 KB)

MBIA Application for 1985 Pool PDF (24 KB)| Microsoft Word (DOC, 48 KB)

Other Forms:

Nursing Home Licensure and Certification Section

Office of Emergency Medical Services