Online Payments
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Application for License to Operate a Long-Term Care Facility
- DA-150 Application for License to Operate a Long Term Care Facility (MO 580-2631)
- DA-637 Assurance of Compliance (MO 580-2622)
- Principal List (MO 580-2925)
- DA-635 Affiliate List - Corporation (MO 580-2626)
- DA-632 Affiliate List - Limited Liability Company (LLC) (MO580-2630)
- DA-633 Affiliate List - Nonprofit Corporation (MO 580-2627)
- DA-634 Affiliate List - Partnership (MO 580-2629)
- DA-150d Relicensure Financial Information Statement - General (MO 580-2633)
- DA 150c Relicensure Financial Information Statement - Sole Proprietor (MO 580-2634)
- DA-150a Statement of Financial Condition - Sole Proprietor (MO 580-2632)
- DA-150e Statement of Financial Position - General (MO 580-2635)
- DA-150b Forecasted Income Statement - All Operators (MO 580-2636)
- DA-639 Noncancelable Escrow Agreement (MO 580-2628)
- DA-638 Nursing Home Surety Bond (MO 580-2624)
- DA-621 Alzheimer's Special Care Services Disclosure (MO 580-2637)
- DA-636 Corrections for Long Term Care Facility License Application (MO 580-2623)
Application for License to Operate an Adult Day Care Program
- Application for License to Operate an Adult Day Care Program
- Alzheimer's Special Care Services Disclosure Form
Other Long Term Care Resources
- Application for Registration as a Qualified Receiver for a Long-Term Care Facility
- Background Checks - A Guide for Long Term Care Facilities
- Bed Listing for Licensure and Certification
- Certification of Electric Wiring
- Change of Administrator-Manager in a Long-Term Care Facility
- Change of Director of Nursing in a Long-Term Care Facility
- Compassionate Care Visitation Guidance
- Electronic Monitoring Device Acknowledgement and Request Form
- Facility Reported Incidents - Initial Reporting Form
- Fire Department Consultation
- Fire Report (DA-115)
- Follow-up Investigation Form
- Guide to Selecting an Alzheimers Special Care Unit
- Instructions for Exception Request (updated 02/10/23)
- Instructions for Second Business Request (updated 02/10/23)
- Long Term Care Regions Map
- PASRR
- Personal Funds Account Balance Report
- Pre-Screening and Assessment for Admission to Assisted Living Facilities