Adult Day Health Care

Obtain Healthcare Licensing Plan Review Approval from the Office of State Fire Marshal

• Phone: 225-925-4920
• Fax:      225-925-4414

Please submit the following requested information with your application.

1. ADHC Licensing Application form
2. Application fee of $600
3. Payment Transmittal Form
4. Letter of Intent (include the ADHC name; address, and if new construction, the construction completion date)
5. Form HSS-1513L (Disclosure of Ownership)
6. Copy of Healthcare Licensing Plan Review Approval Letter
7. Copy of approved floor plan diagram with green stamp approval from the Office of State Fire Marshal
8. A copy of criminal background checks for all owners of the facility | Approved background check agencies
9. Proof of financial viability to include: a line of credit issued from a federally insured, licensed lending institution for at least $50,000
10. Proof of professional liability insurance of at least $300,000
11. Proof of general liability insurance of at least $300,000
12. CLIA (Lab Memo and Application Packet) (Level 4 ARCP)
13. On-site inspection approvals (Offices of Public Health and State Fire Marshal)
    1. Office of Public Health Inspection Report - To request a recommendation for licensure for Sanitarian Services, call 225-342-8954
    2. Office of State Fire Marshal Inspection Report - To request an inspection, notify the District Fire Marshal's Office in your area:
       Baton Rouge District Office: 225-925-4914
       Lafayette District Office: 337-886-1273
       New Orleans District Office: 504-219-4600
       Shreveport District Office: 318-676-7145
       Monroe District Office: 318-362-4696
    3. OPH Plan Review Questionnaire
14. 8x11 floor sketch or drawing of the premises
15. Copy of the Articles of Incorporation
16. PACE providers ONLY: Effective March 1, 2018, all initial license applications shall include a completed Emergency Preparedness Attestation form. 
17. Other Licenses: Approval from any pertinent local agencies as required in your area (zoning, occupation license, local fire ordinance, etc.)

The Health Standards Section will conduct an initial licensing survey to verify compliance with the minimum licensing regulations before issuing the ADHC license.

1. Payments (payable to LDH or LDH Licensing) and Payment Transmittal form must be submitted to the Chase Bank P.O. box below:

• LDH Licensing Fee
  P.O. Box 734350
  Dallas, TX 75373-4350

2. Documentation (Application Form, Disclosure of Ownership, and OPH reports) must be sent to the Health Standards Section at:

• Health Standards Section
  P.O. Box 3767
  Baton Rouge, LA 70821-3767