| Reference No. |
Reference Name |
Link |
Description |
| Ref-02766 |
AHCA HHA Distance 3110-1026 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-02766 |
Applicants for a new home health agency license sign and submit the form to attest that th...
|
| Ref-02767 |
HHA CEMP form 3110-1022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-02767 |
The Comprehensive Emergency Management Plan form is a Word document that home heath agenci...
|
| Ref-03070 |
Health Care Advance Directives - The Patient's Right to Decide |
http://www.flrules.org/Gateway/reference.asp?No=Ref-03070 |
This document is a consumer guide from the Agency's FloridaHealthFinder.gov web site. It ...
|
| Ref-03401 |
Application for Exemption, AHCA Form 3110-0019, September 2013 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-03401 |
Application for Exemption, AHCA Form 3110-0019, September 2013, to be used by individuals ...
|
| Ref-03402 |
Affidavit of Compliance with Background Screening Requirements, AHCA Form 3100-0008, September 2013 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-03402 |
The Affidavit of Compliance with Background Screening Requirements, AHCA Form 3100-0008, S...
|
| Ref-03988 |
Alternate Care Certification Optional State Supplementation |
http://www.flrules.org/Gateway/reference.asp?No=Ref-03988 |
|
| Ref-04003 |
USDA Dietary Guidelines for Americans, 2010 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04003 |
|
| Ref-04004 |
DCF Form CF-ES 1006 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04004 |
|
| Ref-04005 |
DOH Form 1896 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04005 |
|
| Ref-04010 |
Emergency Management Criteria for Assisted Living Facilities |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04010 |
|
| Ref-04011 |
Health Care Services Pool Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04011 |
This is an updated application form for registration of health care services pools. It is ...
|
| Ref-04100 |
Consent to Deliver in a Birth Center, AHCA Form 3130-3003, November 2013 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04100 |
Form used by clients to document written consent to deliver in a birth center.
|
| Ref-04452 |
Health Care Licensing Application, Ambulatory Surgical Centers, AHCA Form 3130-2001 July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04452 |
This form is required for application for licensure as an Ambulatory Surgical Center
|
| Ref-04454 |
Emergency Management Planning Criteria for Ambulatory Surgical Centers, AHCA FORM 3130-2003 July 94 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04454 |
Each ASC is required to develop and adopt a written comprehensive emergency management pla...
|
| Ref-04457 |
Health Care Licensing Application, Transitional Living Facilities, AHCA Form 3110-9001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04457 |
This form is required for an initial, renewal or change of ownership application for licen...
|
| Ref-04487 |
Health Care Licensing Application, Health Care Services Pool, AHCA form 3110-1010, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04487 |
This is required for application for licensure as a Health Care Services Pool
|
| Ref-04588 |
Health Care Licensing Application, Multiphasic Health Testing Center, AHCA 3170-4001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04588 |
|
| Ref-04592 |
Health Care Licensing Application, Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04592 |
Revised July 2014 and incorporated in Rule 59A-13.004
|
| Ref-04594 |
Health Care Licensing Application, Birth Center AHCA Form 3130-3001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04594 |
Application used to apply for a birth center license
|
| Ref-04605 |
Health Care Licensing Application Hospitals, AHCA Form 3130-8001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04605 |
Application used to apply for or modify a hospital license.
|
| Ref-04606 |
“Health Care Advance Directives – The Patient’s Right to Decide,” revised 2006 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04606 |
This document is a consumer guide from the Agency's FloridaHealthFinder.gov web site.
|
| Ref-04607 |
Emergency Services Exemption Request, AHCA Form 3000-1, November 2013 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04607 |
If a hospital is unable to provide a service on a 24 hour per day, 7 day per week basis, e...
|
| Ref-04819 |
Health Care Licensing Application, Abortion Clinic, AHCA Form 3130-1000, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04819 |
Abortion Clinic Licensure Application
|
| Ref-04945 |
Health Care Licensing Application, Health Care Clinics, AHCA Form 3110-0013, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04945 |
Application used to apply for a health care clinic license.
|
| Ref-04946 |
Application for Exemption from Licensure as a Health Care Clinic, AHCA Form 3110-0014, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04946 |
Application form used to apply for a certificate of exemption from licensure as a health c...
|
| Ref-04947 |
Medical/Clinic Director Attestation, AHCA Form 3110-1028 (Sept 2014) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04947 |
Medical/Clinic Director Attestation of Legal Responsibility for a clinic's activities.
|
| Ref-05175 |
Health Care Licensing Application, Health Care Risk Manager, AHCA Form 3130-1015, January 2015 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05175 |
Application used to apply for risk manager license
|
| Ref-05202 |
AHCA Form 3110-3001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05202 |
Application used to apply for a Home for Special Services license
|
| Ref-05234 |
Comprehensive Emergency Management Plan for Nurse Registries, AHCA Form 3110-1017, May 2015 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05234 |
Nurse Registries are required to complete a Comprehensive Emergency Management Plan is req...
|
| Ref-05235 |
Health Care Licensing Application, Nurse Registry, AHCA Form 3110-7004, October 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05235 |
Application used to obtain or amend a Nurse Registry license
|
| Ref-05267 |
Health Care Licensing Application, Home Medical Equipment Provider, AHCA Form 3110-1005, October 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05267 |
Application to obtain or amend a Home Medical Equipment Provider license
|
| Ref-05268 |
Home Medical Equipment Provider, Request to Amend License for Change of Name and/or Address, AHCA Form 3110-1020, October 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05268 |
Form needed for change of name and/or address for Home Medical Equipment Provider
|
| Ref-05305 |
Health Care Licensing Application, Organ Procurement, Tissue Bank, Eye Bank, AHCA Form 3140-2001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05305 |
Certification application for Organ Procurement Organizations, Eye Banks, and Tissue Banks...
|
| Ref-05363 |
Health Care Licensing Application Addendum AHCA Form 3110-1024 October 2009 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05363 |
Supplemental application to be submitted with any application for licensure filed in accor...
|
| Ref-05421 |
Health Care Licensing Application, Homemaker and Companion Services Provider, AHCA Form 3110-1003, December 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05421 |
Application used to apply for or modify a homemaker and companion services provider licen...
|
| Ref-05422 |
Health Care Licensing Application, Home Health Agency, AHCA Form 3110-1011, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05422 |
Application used to apply for or modify a home health agency license
|
| Ref-05423 |
Health Care Licensing Application, Clinical Laboratories_Non-waived, AHCA Form 3170-2004, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05423 |
Application used to apply for a clinical laboratory license (initial, renewal, CHOW).
|
| Ref-05424 |
Health Care Licensing Application, Clinical Laboratories-Non-waived (Addition of Specialty, Subspecialty or Change in Specialty at Time Other than Licensure Renewal), AHCA Form 3170-2004D |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05424 |
Application used to add a specialty or subspecialty to an existing clinical laboratory lic...
|
| Ref-05425 |
Health Care Licensing Application, Drug-Free Workplace Laboratory, AHCA Form 3170-5001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05425 |
Application used to obtain a Forensic Toxicology Laboratory license
|
| Ref-05435 |
Application for Exemption, AHCA Form 3110-0019, May 2015 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05435 |
Application for an exemption from disqualification for background screenings.
|
| Ref-05436 |
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, May 2015 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05436 |
Attestation of compliance with the requirements of background screening, pursuant to Flori...
|
| Ref-05456 |
Application for Plan Review, AHCA Form 3500-0011, June 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05456 |
Application used for submitting construction projects for review.
|
| Ref-05616 |
Dietary Guidlines for Americans 2010 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05616 |
|
| Ref-05899 |
Application for Nursing Home Gold Seal Award, AHCA Form 3110-0007, October 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05899 |
Application used to apply for the Nursing Home Gold Seal Award.
|
| Ref-06014 |
Health Care Licensing Application Nursing Homes, AHCA Form 3110-6001, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06014 |
Nursing Home Health Care Licensing Application
|
| Ref-06016 |
Nursing Home Patient Trust Surety Bond, AHCA Form 3110-6002, May 2008 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06016 |
Nursing Home Patient Trust Surety Bond, AHCA Form 3110-6002, May 2008
|
| Ref-06017 |
Nursing Home Transfer and Discharge Notice, AHCA Form 3120-0002, April 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06017 |
Nursing Home Transfer and Discharge Notice, AHCA Form 3120-0002, April 2014
|
| Ref-06018 |
Fair Hearing Request for Transfer or Discharge From a Nursing Home, AHCA Form 3120-0003, April 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06018 |
Fair Hearing Request for Transfer or Discharge From a Nursing Home, AHCA Form 3120-0003, A...
|
| Ref-06019 |
Long-Term Care Ombudsman Council Request for Review of Nursing Home Discharge and Transfer, AHCA Form 3120-0004, April 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06019 |
Long-Term Care Ombudsman Council Request for Review of Nursing Home Discharge and Transfer...
|
| Ref-06020 |
Solicitud de Revisión de Long-Term Care Ombudsman de la Dada de Alta o El Traslado de un Hogar de Ancianos, AHCA Form 3120-0004A, April 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06020 |
Solicitud de Revisión de Long-Term Care Ombudsman de la Dada de Alta o El Traslado de un H...
|
| Ref-06021 |
Health Care Advance Directives – The Patient’s Right to Decide, effective April 2006 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06021 |
Health Care Advance Directives – The Patient’s Right to Decide, effective April 2006
|
| Ref-06022 |
Emergency Management Planning Criteria for Nursing Home Facilities, AHCA 3110-6006, March, 1994 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06022 |
Emergency Management Planning Criteria for Nursing Home Facilities, AHCA 3110-6006, March,...
|
| Ref-06023 |
Fire Incident Report, AHCA form 3500-0031, July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06023 |
Fire Incident Report, AHCA form 3500-0031, July 2014
|
| Ref-06024 |
Application for Plan Review, AHCA Form 3500-0011, June 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06024 |
Application for Plan Review, AHCA Form 3500-0011, June 2014
|
| Ref-06174 |
Nursing Home Tables I, II and III, effective March 1, 2002 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06174 |
Nursing Home Tables I, II and III, effective March 1, 2002
|
| Ref-06175 |
AHCA Form 3110-5003 Intermediate Care Facilities for Developmentally Disabled July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06175 |
AHCA Form 3110-5003 Intermediate Care Facilities for Developmentally Disabled July 2014
|
| Ref-06199 |
Fire Incident Report, AHCA Form 3500-0031, Revised July 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06199 |
Fire Incident Report, AHCA Form 3500-0031, Revised July 2014
|
| Ref-06268 |
Birth Center Annual Report, AHCA Form 3130-3004 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06268 |
Form used to file a birth center annual report
|
| Ref-06375 |
Title 42 Code of Federal Regulations section 483.12(a), revision date October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06375 |
Title 42 Code of Federal Regulations section 483.12(a), revision date October 1, 2014
|
| Ref-06376 |
42 CFR, Section 483.15(h)(6), October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06376 |
42 CFR, Section 483.15(h)(6), October 1, 2014
|
| Ref-06377 |
Title VI of the Civil Rights Act of 1964, § 2000, effective date July 2, 1964 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06377 |
Title VI of the Civil Rights Act of 1964, § 2000, effective date July 2, 1964
|
| Ref-06378 |
Title 42 C.F.R. §§ 483.25(1) and 483.25(m), effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06378 |
Title 42 C.F.R. §§ 483.25(1) and 483.25(m), effective October 1, 2014
|
| Ref-06379 |
42 C.F.R. § 483.60, effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06379 |
42 C.F.R. § 483.60, effective October 1, 2014
|
| Ref-06382 |
Title 42 Code of Federal Regulation 483.75, effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06382 |
Title 42 Code of Federal Regulation 483.75, effective October 1, 2014
|
| Ref-06383 |
42 CFR 483.30, effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06383 |
42 CFR 483.30, effective October 1, 2014
|
| Ref-06385 |
42 CFR 483, Requirements for State and Long Term Care Facilities, October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06385 |
42 CFR 483, Requirements for State and Long Term Care Facilities, October 1, 2014 (Parts 1...
|
| Ref-06388 |
45 Code of Federal Regulation, Section 164, Effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06388 |
45 Code of Federal Regulation, Section 164, Effective October 1, 2014 (Sections 164.102-16...
|
| Ref-06389 |
45 Code of Federal Regulation, Section 164, Effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06389 |
45 Code of Federal Regulation, Section 164, Effective October 1, 2014 (Section 164.512-164...
|
| Ref-06401 |
Title 42 CFR, Sections 483.420(b)(1)-(2), effective October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06401 |
Title 42 CFR, Sections 483.420(b)(1)-(2), effective October 1, 2014
|
| Ref-06402 |
42 CFR 483.430(d)(3), dated October 1, 2014 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06402 |
42 CFR 483.430(d)(3), dated October 1, 2014
|
| Ref-06701 |
Monthly Report of Induced Terminations of Pregnancy, AHCA Form 3130-1010 OL, February 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06701 |
Form for monthly ITOP reporting.
|
| Ref-06986 |
AHCA Form 3130-1016, May 2016, Verification of Practical Experience |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06986 |
Form used to verify experience to qualify for initial licensure as a health care risk mana...
|
| Ref-07060 |
Health Care Licensing Application, Home Health Agency, AHCA Form 3110-1011, March 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07060 |
Application form used to obtain or amend a home health agency license
|
| Ref-07061 |
Health Care Licensing Online Application, Home Health Agency, AHCA Form 3110-1011OL, March 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07061 |
Application form used to renew a home health agency license online.
|
| Ref-07162 |
Health Care Licensing Application, Nurse Registry, AHCA Form 3110-7004, March 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07162 |
Application form used to apply for or amend a nurse registry license
|
| Ref-07163 |
Health Care Licensing Online Application, Nurse Registry, AHCA Form 3110-7004OL, March 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07163 |
Online application form used to renew a nurse registry license
|
| Ref-07333 |
Monthly Report of Induced Terminations of Pregnancy, AHCA Form 3130-1010 OL, July 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07333 |
Online form for reporting monthly ITOP data.
|
| Ref-07440 |
Health Care Licensing Application, Abortion Referral or Counseling Agency, AHCA Form 3130-1020, July 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07440 |
Application used to register as an Abortion Referral or Counseling Agency.
|
| Ref-07591 |
Monthly Report of Induced Terminations of Pregnancy, AHCA Form 3130-1010 OL, January 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07591 |
This online form is for providers to report data in relation to terminations of pregnancy ...
|
| Ref-07596 |
Health Care Licensing Application, Abortion Clinic, AHCA Form 3130-1000, July 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07596 |
Application used to apply for an abortion clinic license
|
| Ref-07597 |
Health Care Licensing Online Application, Abortion Clinics, AHCA Form 3130-1000OL, July 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07597 |
Online application used to renew an abortion clinic license
|
| Ref-07598 |
Refusal to Permit Administration of Rho(D) Immune Globulin, AHCA Form 3130-1002, July 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07598 |
Form to document patient refusal to permit administration of Rho(D) Immune Globulin.
|
| Ref-07599 |
Abortion Clinic Incident Report Form, AHCA Form 3130-1003, July 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07599 |
Form used to document incidents that result in serious injury at an abortion clinic.
|
| Ref-07613 |
Application for Nursing Home Gold Seal Award, AHCA Form 3110-0007 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07613 |
Application for Nursing Home Gold Seal Award, AHCA Form 3110-0007, September 2016
|
| Ref-08458 |
Health Care Registration, Abortion Referral or Counseling Agency, AHCA Form 3130-1020, February 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08458 |
Required form used to register an Abortion Referral or Counseling Agency
|
| Ref-08776 |
Health Maintenance Organization Adverse Incident Report, HMO Adverse Incident, AHCA Form 3140-5003 OL, April 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08776 |
Health Maintenance Organization Adverse Incident Report, HMO Adverse Incident, AHCA Form 3...
|
| Ref-08777 |
Nursing Home Adverse Incident, AHCA Form 3110-0010 OL, April 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08777 |
Nursing Home Adverse Incident, AHCA Form 3110-0010 OL, April 2017
|
| Ref-08778 |
Assisted Living Facility Adverse Incident, AHCA Form 3180-1025 OL, April 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08778 |
Assisted Living Facility Adverse Incident, AHCA Form 3180-1025 OL, April 2017
|
| Ref-08779 |
Hospital Adverse Incident, AHCA Form 3140-5001 OL, April 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08779 |
Hospital Adverse Incident, AHCA Form 3140-5001 OL, April 2017
|
| Ref-08780 |
Ambulatory Surgical Center Adverse Incident, AHCA Form 3140-5004 OL, April 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08780 |
Ambulatory Surgical Center Adverse Incident, AHCA Form 3140-5004 OL, April 2017
|
| Ref-09009 |
OPTN policies, effective April 6, 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09009 |
Organ Procurement and Transplantation Network policies
|
| Ref-09010 |
“PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission Through Organ Transplantation”, as published in Public Health Reports/July-August 2013/Volume 128 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09010 |
Guidance document for determining whether a potential donor is at increased risk of transm...
|
| Ref-09011 |
21 CFR Part 1270, 2010 Edition |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09011 |
Food and Drug Administration regulations for Human Tissue Intended for Transplantation.
|
| Ref-09012 |
21 CFR Part 1271, 2012 Edition |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09012 |
Food and Drug Administration regulations regarding Human Cells, Tissues, and Cellular and ...
|
| Ref-09014 |
42 CFR Parts 413, 441, 486, and 498, effective May 31, 2006 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09014 |
42 CFR Parts 413, 441, 486, and 498, effective May 31, 2006
|
| Ref-09015 |
Occupational Safety and Health Administration (OSHA) rules 29 Code of Federal Regulations (CFR) Part 1910.1030, effective April 3, 2012 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09015 |
Occupational Safety and Health Administration regulations regarding blood borne pathogens.
|
| Ref-09016 |
FDA Guidance for Industry “Eligibility Determination for Donors of Human Cells, Tissues and Cellular and Tissue-based Products (HCT / Ps)”, August 2007 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09016 |
Guidance for use with tissues from donors who have been transfused.
|
| Ref-09080 |
Annual Report, AHCA Form 3140-5002 OL, Dec 2001 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09080 |
Annual Report, AHCA Form 3140-5002 OL, Dec 2001
|
| Ref-09105 |
Background Screening Application for Exemption, AHCA Form 3110-0019, January 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09105 |
Background Screening Application for Exemption, AHCA Form 3110-0019, January 2017
|
| Ref-09106 |
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, January 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09106 |
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, Jan...
|
| Ref-09170 |
AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, March 2017 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09170 |
|
| Ref-09321 |
Health Care Licensing Application, Transitional Living Facility, AHCA Form 3110-9001, January 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09321 |
Health Care Licensing Application, Transitional Living Facility, AHCA Form 3110-9001, Janu...
|
| Ref-09326 |
USDA Dietary Guidelines for Americans, 2015-2020, Eighth Edition |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09326 |
USDA Dietary Guidelines for Americans, 2015-2020, 8th Edition
|
| Ref-09393 |
Notification of Change of Administrator form, AHCA Form 3180-1006, June 2016 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09393 |
|
| Ref-09635 |
License Application Adult Inpatient Diagnostic Cardiac Catheterization Services, AHCA Form 3130-5003, January 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09635 |
Application to apply for the Adult Inpatient Diagnostic Cardiac Catheterization licensed p...
|
| Ref-09636 |
License Application Level I Adult Cardiovascular Services, AHCA Form 3130-8010, January 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09636 |
Application to apply for the Level I Adult Cardiovascular Services program.
|
| Ref-09637 |
License Application Level II Adult Cardiovascular Services, AHCA Form 3130-8011, January 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09637 |
Application to apply for the Level II Adult Cardiovascular Services program.
|
| Ref-09638 |
License Application Stroke Center Affidavit, AHCA Form 3130-8009, January 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09638 |
Application to apply for a Stroke Center program
|
| Ref-09639 |
License Application Burn Unit Services, AHCA Form 3130-8012, January 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09639 |
Application to apply for the burn unit licensed program
|
| Ref-10148 |
Health Care Licensing Application, Birth Center, AHCA Form 3130-3001, June 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10148 |
Application used to apply for birth center license
|
| Ref-10149 |
Health Care Licensing Online Application, Birth Center, AHCA Form 3130-3001OL, June 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10149 |
Online application to apply for a birth center license.
|
| Ref-10284 |
Application for Certificate of Exemption from Licensure as a Health Care Clinic |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10284 |
Application used to apply for an exemption from licensure as a Health Care Clinic.
|
| Ref-10296 |
Health Care Licensing Application, Ambulatory Surgical Center, AHCA Form 3130-2001, September 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10296 |
Application used to apply for an ambulatory surgical center license
|
| Ref-10297 |
Health Care Licensing Online Application, Ambulatory Surgical Center, AHCA Form 3130-2001OL, September 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10297 |
Online application used to apply for an ambulatory surgical center license
|
| Ref-10381 |
Application for Exemption from Licensure as a Home Health Agency, AHCA Form 3110-1009, July 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10381 |
Application used to apply for an exemption from licensure as a Home Health Agency.
|
| Ref-10434 |
Birth Center Annual Report, AHCA Form 3130-3004OL, February 2019 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10434 |
Online form to be used for completing the required annual report for birth centers.
|
| Ref-10652 |
AHCA Form 3130-8013, July 2018, License Application Alternate-Site Testing |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10652 |
For hospitals to record alternate-site testing performed out of the physical or administra...
|
| Ref-10855 |
Abortion Clinic Incident Report, AHCA Form 3130-1003OL, March 2019 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10855 |
An online reporting system for abortions clinics to report adverse incidents.
|
| Ref-12123 |
Annual Report, AHCA Form 3140-5005 OL, May 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-12123 |
Online annual report form for use by Hospitals and ambulatory surgical centers.
|
| Ref-12147 |
Annual Report, AHCA Form 3140-5002 OL, May 2018 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-12147 |
Online Annual Report form for HMOs
|
| Ref-12455 |
Health Care Licensing Application, Home Health Agency, AHCA Form 3110-1011, April 2019 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-12455 |
Application for Home Health Agency licensure.
|
| Ref-12456 |
Health Care Licensing Online Application, Home Health Agency, AHCA Form 3110-1011OL, April 2019 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-12456 |
Online application for home health agency licensure.
|
| Ref-13012 |
Hospital Outpatient Observation Notice, AHCA Form 3190-2000, April 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13012 |
To be incorporated in rule 59A-3.270
|
| Ref-13013 |
Quality Measures and Patient Safety Information, AHCA Form 3190-2001OL, April 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13013 |
To be incorporated in rule 59A-3.270
|
| Ref-13531 |
AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, April 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13531 |
|
| Ref-13996 |
Health Care Licensing Application Intermediate Care Facilities for Developmentally Disabled; AHCA Form 3110-5003 April 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13996 |
Hard copy application to be incorporated in rule 59A-26.002
|
| Ref-13997 |
Health Care Licensing Application Intermediate Care Facilities for Developmentally Disabled; AHCA Form 3110-5003 OL April 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13997 |
Online application to be incorporated in rule 59A-26.002
|
| Ref-13999 |
Application for Exemption from Licensure as a Home Health Agency AHCA Form 3110-1009 July 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13999 |
Hard copy application to be incorporated in rule 59A-8.005
|
| Ref-14000 |
Income and Expense Statement AHCA Form 3180-1017 August 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14000 |
hard copy form to be incorporated in 59A-37.002
|
| Ref-14001 |
Local Zoning Form AHCA Form 3180-1021 August 2021 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14001 |
Hard copy form to be incorporated in rule 59A-37.002
|
| Ref-14115 |
Health Care Licensing Application Birth Centers AHCA Form 3130-3001 January 2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14115 |
To be incorporated in rule 59A-11.003
|
| Ref-14116 |
Health Care Licensing Application Birth Center; AHCA Form 3130-3001 OL January 2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14116 |
To be incorporated in rule 59A-11.003
|
| Ref-14117 |
Birth Center Annual Report AHCA Form 3130-3004 OL January 2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14117 |
To be incorporated rule 59A-11.019
|
| Ref-14931 |
Monthly Report of Induced Terminations of Pregnancy, AHCA Form 3130-1010 OL, July 2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14931 |
Monthly report for abortion clinics
|
| Ref-14971 |
Health Care Licensing Application Hospital, AHCA Form 3130-8001, July 2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14971 |
|
| Ref-14972 |
Health Care Licensing Online Application, Hospital, AHCA Form 3130-8001OL, July 2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14972 |
|
| Ref-14999 |
ASC_Patient_Safety_Culture_Survey_AHCA_Form_3130-8017_October2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-14999 |
|
| Ref-15000 |
ASC_PSCS_Data_Entry_Tool_AHCA_Form_3130-8017A_October_2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15000 |
|
| Ref-15001 |
ASC_PSCS_Guide_and_Data_File_Specifications_AHCA_Form_3130-8016_October2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15001 |
|
| Ref-15002 |
Hospital_Patient_Safety_Culture_Survey_AHCA_Form_3130-8015_October2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15002 |
|
| Ref-15003 |
Hospital_PSCS_DataEntryTool_AHCA_Form_3130-8015A_October_2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15003 |
|
| Ref-15004 |
Hospital_PSCS_Guide_and_Data_File_Specifications_AHCA_Form_3130-8014_October_2022 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15004 |
|
| Ref-15408 |
Excellence in Home Health Award Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15408 |
|
| Ref-15964 |
Minimum Emergency Management Planning Criteria for Assisted Living Facilities |
http://www.flrules.org/Gateway/reference.asp?No=Ref-15964 |
Used to develop a Comprehensive Emergency Management Plan for assisted living facilities.
|
| Ref-16384 |
Health Care Licensing Application Addendum AHCA Form 3110-1024 August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16384 |
|
| Ref-16385 |
Health Care Licensing Application Abortion Clinic, AHCA Form 3130-1000, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16385 |
|
| Ref-16386 |
Health Care Licensing Online Application Abortion Clinic, AHCA Form 3130-1000OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16386 |
|
| Ref-16387 |
Health Care Licensing Application Adult Day Care Center, AHCA Form 3180-1004, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16387 |
|
| Ref-16388 |
Health Care Licensing Online Application Adult Day Care Center, AHCA Form 3180-1004OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16388 |
|
| Ref-16389 |
Health Care Licensing Application Adult Family-Care Home, AHCA Form 3180-1022, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16389 |
|
| Ref-16390 |
Health Care Licensing Online Application Adult Family-Care Home, AHCA Form 3180-1022OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16390 |
|
| Ref-16391 |
Health Care Licensing Application Ambulatory Surgical Center, AHCA Form 3130-2001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16391 |
|
| Ref-16392 |
Health Care Licensing Online Application Ambulatory Surgical Center, AHCA Form 3130-2001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16392 |
|
| Ref-16393 |
Health Care Licensing Application Assisted Living Facilities, AHCA Form 3110-1008, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16393 |
|
| Ref-16394 |
Health Care Licensing Online Application Assisted Living Facilities, AHCA Form 3110-1008OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16394 |
|
| Ref-16395 |
Health Care Licensing Application Birth Center, AHCA Form 3130-3001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16395 |
|
| Ref-16396 |
Health Care Licensing Online Application Birth Center, AHCA Form 3130-3001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16396 |
|
| Ref-16397 |
Health Care Licensing Application Crisis Stabilization Unit or Short-Term Residential Treatment Facility, AHCA Form 3180-5003, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16397 |
|
| Ref-16398 |
Health Care Licensing Online Application Crisis Stabilization Unit or Short-Term Residential Treatment Facility, AHCA Form 3180-5003OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16398 |
|
| Ref-16399 |
Health Care Licensing Application Forensic Toxicology Laboratory, AHCA Form 3170-5001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16399 |
|
| Ref-16400 |
Health Care Licensing Online Application Forensic Toxicology Laboratory, AHCA Form 3170-5001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16400 |
|
| Ref-16401 |
Health Care Licensing Application Health Care Clinic, AHCA Form 3110-0013, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16401 |
|
| Ref-16402 |
Health Care Licensing Online Application Form Health Care Clinic, AHCA Form 3110-0013OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16402 |
|
| Ref-16403 |
Health Care Licensing Application Health Care Services Pool, AHCA Form 3110-1010, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16403 |
|
| Ref-16404 |
Health Care Licensing Online Application Health Care Services Pool, AHCA Form 3110-1010OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16404 |
|
| Ref-16405 |
Health Care Licensing Application Home Health Agencies, AHCA Form 3110-1011, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16405 |
|
| Ref-16406 |
Health Care Licensing Online Application Home Health Agencies, AHCA Form 3110-1011OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16406 |
|
| Ref-16407 |
Health Care Licensing Application Home Medical Equipment Provider AHCA Form 3110-1005, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16407 |
|
| Ref-16408 |
Health Care Licensing Online Application Home Medical Equipment Provider AHCA Form 3110-1005OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16408 |
|
| Ref-16409 |
Health Care Licensing Application Homemaker and Companion Services Provider, AHCA Form 3110-1003, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16409 |
|
| Ref-16410 |
Health Care Licensing Online Application Homemaker and Companion Services Provider, AHCA Form 3110-1003OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16410 |
|
| Ref-16411 |
Health Care Licensing Application Hospice, AHCA Form 3110-4001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16411 |
|
| Ref-16412 |
Health Care Licensing Online Application Hospice, AHCA Form 3110-4001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16412 |
|
| Ref-16413 |
Health Care Licensing Application Hospitals, AHCA Form 3130-8001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16413 |
|
| Ref-16414 |
Health Care Licensing Online Application Hospitals AHCA Form 3130-8001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16414 |
|
| Ref-16415 |
Health Care Licensing Application Intermediate Care Facilities for the Developmentally Disabled, AHCA Form 3110-5003, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16415 |
|
| Ref-16416 |
Health Care Licensing Online Application Intermediate Care Facilities for the Developmentally Disabled, AHCA Form 3110-5003OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16416 |
|
| Ref-16417 |
Health Care Licensing Application Nurse Registry, AHCA Form 3110-7004, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16417 |
|
| Ref-16418 |
Health Care Licensing Online Application Nurse Registry, AHCA Form 3110-7004OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16418 |
|
| Ref-16419 |
Health Care Licensing Application Nursing Home, AHCA Form 3110-6001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16419 |
|
| Ref-16420 |
Health Care Licensing Online Application Nursing Home, AHCA Form 3110-6001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16420 |
|
| Ref-16421 |
Health Care Licensing Application Organ Procurement Organization, Tissue Bank, Eye Bank, AHCA Form 3140-2001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16421 |
|
| Ref-16422 |
Health Care Licensing Online Application Organ Procurement Organization, Tissue Bank, Eye Bank, AHCA Form 3140-2001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16422 |
|
| Ref-16423 |
Health Care Licensing Application Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16423 |
|
| Ref-16424 |
Health Care Licensing Online Application Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16424 |
|
| Ref-16425 |
Health Care Licensing Application Residential Treatment Center for Children and Adolescents, AHCA Form 3180-5004, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16425 |
|
| Ref-16426 |
Health Care Licensing Online Application Residential Treatment Center for Children and Adolescents, AHCA Form 3180-5004OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16426 |
|
| Ref-16427 |
Health Care Licensing Application Residential Treatment Facility, AHCA Form 3180-5005, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16427 |
|
| Ref-16428 |
Health Care Licensing Online Application Residential Treatment Facility, AHCA Form 3180-5005OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16428 |
|
| Ref-16429 |
Health Care Licensing Application Transitional Living Facility, AHCA Form 3110-9001, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16429 |
|
| Ref-16430 |
Health Care Licensing Online Application Transitional Living Facility, AHCA Form 3110-9001OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16430 |
|
| Ref-16431 |
Application for Certificate of Exemption from Licensure as a Health Care Clinic, AHCA From 3110-0014, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16431 |
|
| Ref-16432 |
Online Application for Certificate of Exemption from Licensure as a Health Care Clinic, AHCA Form 3110-0014OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16432 |
|
| Ref-16433 |
Application for Certificate of Exemption from Licensure as a Home Health Agency, AHCA Form 3110-1009, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16433 |
|
| Ref-16434 |
Online Application for Certificate of Exemption from Licensure as a Home Health Agency, AHCA Form 3110-1009OL, August 2023 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16434 |
|