Home Medical Equipment Licensing Board Forms and Applications

• HME Facility Change of Information/Replacement Request Form 

• HME Facility License Application (Non-accredited facilities)

• HME Facility Certificate of Registration Application (Accredited facilities)

• Facility Self Evaluation for Ohio HME Regulation

• Affidavit of Exception

• Certificate of Accreditation

• Complaint Form

The Board encourages HME candidates to complete a Facility Self Evaluation Form to determine if a license or certificate of registration is required to provide HME services. Ohio law regulates a select number of equipment services defined under ORC Section 4752.01 (B) and OAC rule 4761:1-3-02. If a facility does not provide one of the defined services, the facility may be accepted from the HME licensure requirements under ORC Chapter 4752. The Board encourages facilities to seek legal representation to review your qualifications for a license, certificate of registration or an exception to licensure requirements.

If you have any questions, please contact us at 614-644-4732.