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Applications and Forms

Health Services Regulation

pdf Complaint Form (All complaints should be addressed with the hospital first)


Provider Information

pdf Hospital Licensure Renewal Application
pdf Bed Count Sheet
pdf Infectious Waste Generator Registration Application

Provider Information forms must be notarized and returned via regular mail to:

Health Services Regulation
Missouri Department of Health and Senior Services
P.O. Box 570
Jefferson City, MO  65102-0570