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Application & Forms

Contact Information
Bureau of Ambulatory Care

PO Box 570
Jefferson City, MO 65102-0570

Fax: 573-751-6648

Phone

Find essential Applications & Forms for Missouri ASCs to maintain compliance with state licensing and operational standards. Providers can access critical documents such as the ASC Licensure Renewal Application, Change of Administrator, and CARE ACT Form. Completed forms can be submitted directly to the Bureau of Ambulatory Care via email or traditional mail. These resources are designed to help facilities navigate regulatory requirements while ensuring the safety and quality of care for all patients.

How to Report a Complaint

If you have concerns about patient care, infection control, or any other issue involving an Ambulatory Surgery Center (ASC), you can report them to the Missouri Department of Health and Senior Services (DHSS) using any of the options below:

  • Call the State Hotline toll‑free at (800) 392‑0210
  • Call the Bureau of Ambulatory Care at (573) 751‑1588
  • Email the Bureau of Ambulatory Care at BAC@health.mo.gov

Please note: Calls and emails received after normal business hours will be returned the next business day.