Checklist for Initial Licensure- Pediatric Day Health Care (PDHC) Facility

A completed initial license application packet for a PDHC facility must be submitted to and approved by the department prior to an applicant providing PDHC facility services.  An applicant must submit a completed initial licensing packet to the department, which shall include:

  1. Facility Need Review Approval Letter
  2. a completed Pediatric Day Health Care licensure application (HSS Form)
  3. a non-refundable licensing fee of $600 (Payment Procedure)
  4. a copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal (OSFM) Health Care licensing plan review internet site - http://sfm.dps.louisiana.gov/pr_healthcare.htm OSFM plan review contact information: Phone 225-925-4920 or Fax 225-925-4414
  5. a copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshall
  6. a copy of the health inspection report with approval of occupancy from the Office of Public Health
  7. a copy of a statewide criminal background check conducted by the Louisiana State Police, or its authorized agency, on all individual owners with a 5% or more ownership interest in the PDHC facility, and o all members of the board of directors, and administrator. (Criminal Background Check website)
  8. proof of financial viability comprised of the following:
    1. a letter of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000;
    2. proof of general and professional liability insurance of at least $300,000;
    3. proof of worker’s compensation insurance;
  9. if applicable, clinical laboratory improvement amendments (CLIA) certificate;
  10. disclosure of ownership and control information;
  11. a floor sketch or drawing of the premises to be licensed;
  12. a copy of the articles of organization or articles of incorporation;
  13. qualifications for administrator, director of nursing, and medical director
  14. a signed attestation statement from a licensed electrician attesting to the correct installation of a fully functioning generator and that generator is of sufficient wattage to power the facility.

If the initial licensing packet is incomplete when submitted, the applicant will notified of the missing information and will have 90 days from receipt of notification to submit the additional requested information.  If the additional requested information is not submitted to the department within 90 days of notification, the application will be closed.