An Independently Licensed RHC that is Certified as an Independent RHC but Provider Based to the Hospital

The information and forms in this packet are designed to assist providers in submitting the information for the initial licensing and certification of an independently licensed and certified Rural Health Clinic that is provider based, but not licensed to, a hospital.  Please mail the packet to the Department of Health and Hospitals, Health Standards Section, P. O. Box 3767, Baton Rouge, LA 70821. Any fees associated with the application should be sent to LDH-Licensing, P.O. Box 62949, New Orleans, LA 70162-2949.


 CMS Forms (please visit the CMS website for most recent version)

 Accreditation Organizations Approved for Rural Health Clinics

 Other Agencies:

  • Office of State Fire Marshal Inspections
    • Louisiana Administrative Code 55:V:103 - As of July 1, 2004, the plans and specifications for every structure built or remodeled in the state of Louisiana must be drawn in accordance with the requirements of the specified edition of the Life and Safety Code (excluding Chapter 5 and all TIA's) of the National Fire Protection Association.
    • Most licensing actions require a walk through inspection by the Office of State Fire Marshal. You can contact the Health Care Division of the Office of State Fire Marshal at 800-256-5452 or 225-925-4270. You can also obtain information and instructions online.
  • Office of Public Health Inspections
    • Most licensing actions require a walk through inspection by the Office of Public Health. You can contact Aimee Jaffurs with the Building & Premises Program of the Office of Public Health at 225-342-7523 to obtain information on scheduling your onsite public health inspection. You can also reach her by email at
    • Please remember that the inspection approval report must indicate the correct name & location of the hospital and/or off-site campus. In addition, the report must indicate the areas being inspected.
  • Louisiana Board of Pharmacy
    • To arrange for your Controlled Dangerous Substance license, call 225-925-6496.
  • Drug Enforcement Agency
  • CLIA
  • DEQ