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Forms

Process:
Notification to the director must be filed by a prospective service provider at least 30 days prior to initiating a new HCS or reactivating a discontinued or temporarily suspended HCS. The written notice must contain the name, address and telephone number of the facility where the HCS will be located, the type of HCS to be provided and the projected date of initiation of the HCS. An acknowledgement of receipt of the notification will be sent by the Ohio Department of Health (ODH) with an HCS Notification Survey and Attestation of Compliance, which must be completed and returned to ODH prior to initiating the service. A revised Attestation of Compliance must be filed within 30 days of a change in the personnel signing a previously filed attestation. The program ensures compliance with the quality rules through self attestation of compliance by the service provider and site visits.

Every Adult Cardiac Catheterization Service is required to file an Annual Report with the Department of Health.  The content of the Annual Report varies depending on the service level.  See OAC 3701-84-30.1(I) (Level 1); 3701-84-30.2(M) (Level 2); OAC 3701-4-30.3(J) (Level 3).  

If you have questions regarding your OHCS#, please contact the Department.

Contact Information:  For solid organ transplantation, bone marrow transplantation, adult cardiac catheterization, adult open heart surgery , pediatric cardiac catheterization, and pediatric cardiovascular surgery services: 

Mailing Address:
Ohio Department of Health
Office of Health Assurance and Licensing - Health Care Services
246 North High Street
Columbus, OH 43215

Telephone: (614) 466-4627
Fax: (614) 564-2480

E-mail: HCSDATA@odh.ohio.gov


Page Updated: 3/28/2018