The Mobile Out-of-State Health Care Entity Registration Program registers any entity that is from out of state, licensed or registered under the laws of another state, foreign country, or province of a foreign country and provides health care services in a mobile facility or temporary location for a short period of time in Indiana.
Indiana State Department of Health
Division of Acute Care
2 North Meridian Street, 4A
Indianapolis, IN 46204
(317) 233-7474 (Acute Care Receptionist)
(317) 233-1325 (ISDH Main Switchboard)
(317) 233-7742 [Secretary]
Report a complaint regarding a health care facility
Individuals can call or email to make complaints about care provided at any licensed or certified Indiana health care providers or suppliers.
Report an incident regarding a health care facility
The Incident Report Form is for health care facilities to notify the Indiana State Department of Health of a reportable incident pursuant to the ISDH Reportable Unusual Occurrence Policy. The Incident Report Form is also for health care facility staff (nursing homes, intermediate care facilities, and hospice agencies) to report a reasonable suspicion of a crime against a resident pursuant to Federal regulations. This form is not to be used to file a complaint.
To apply for an initial certificate of registration to operate an out of state mobile health care entity complete the “Application For Registration To Operate An Out of State Mobile Health Care Entity (SF 53398)" and submit with all required information to the Indiana State Department of Health.
Change of Ownership Application
To apply for a change of ownership for an existing facility agency complete the “Application for Registration to operate an out of State Mobile Health Care Entity (SF 53398)" and submit with the purchase agreement and all required information to the Indiana State Department of Health.
Click on the topics below for the applicable instruction letter, application, laws and rules for initial registration or change of ownership application process. Review all applicable information prior to submission of application to the Department.
Select the “Initial Certificate of Registration Application Instruction Letter” for an initial certificate of registration application or the “Change of Ownership Application Instruction Letter” for a change of ownership application.
Initial or Change of Ownership Application Form
Click on the topics below for the application and instructions on how to complete the certificate of registration renewal application.