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Licensing Requirements - Freestanding Emergency Medical Care Facilities

License Application

The following documents, fees, and actions shall be completed and approved before a license will be issued:

Initial Application

  • A license application form (PDF, 262KB) shall be submitted no earlier than 90 calendar days prior to the projected opening date of the facility.
  • A license fee of $14,820.00 shall be submitted. License fees are not refundable.
  • Patient Transfer Documents:
    • A copy of the facility’s Patient Transfer Policy that is in accordance with §131.66 Patient Transfer Policy, and signed by the Chairman and Secretary of the Governing Body shall be submitted.
    • A copy of the facility’s Memorandum of Transfer form that is in accordance with §131.66(b)(9) shall be submitted.
    • A copy of the facility’s Patient Transfer Agreement with a General Hospital that is in accordance with §131.67 Patient Transfer Agreements shall be submitted.
    • Please submit transfer documents to Lisa Peers, RN, BSN, Nurse Consultant, at lisa.peers@dshs.state.tx.us or fax to (512) 834-4514 for approval. Ms. Peers may also be contacted by telephone at (512) 834-6600, extension 2615.
  • A completed Fire Safety Survey Report form shall be submitted. Annual fire safety inspections are required for continued licensure status. Please include a copy of a fire inspection report conducted within the last 12 months indicating approval by the local fire authority.
  • Approval for occupancy shall be obtained from the Department of State Health Services, Architectural Review Group.
  • The applicant or the applicant’s representative shall attend a pre-survey conference at the zone office designated by the department. Please contact the designated zone office to schedule the pre-survey conference

Relocation Application

  • A license application form (PDF, 262KB) shall be submitted no earlier than 90 calendar days prior to the projected opening date of the facility.
  • A license fee of $14,820.00 shall be submitted. License fees are not refundable.
  • Patient Transfer Documents:
    • A copy of the facility’s Patient Transfer Policy that is in accordance with §131.66 Patient Transfer Policy, and signed by the Chairman and Secretary of the Governing Body shall be submitted.
    • A copy of the facility’s Memorandum of Transfer form that is in accordance with §131.66(b)(9) shall be submitted.
    • A copy of the facility’s Patient Transfer Agreement with a General Hospital that is in accordance with §131.67 Patient Transfer Agreements shall be submitted.
    • Please submit transfer documents to Lisa Peers, RN, BSN, Nurse Consultant, at lisa.peers@dshs.state.tx.us or fax to (512) 834-4514 for approval. Ms. Peers may also be contacted by telephone at (512) 834-6600, extension 2615.
  • A copy of the letter of accreditation by the Joint Commission or another accrediting organization verifying accreditation and the effective date of accreditation.
  • A completed Fire Safety Survey Report form shall be submitted. Annual fire safety inspections are required for continued licensure status. Please include a copy of a fire inspection report conducted within the last 12 months indicating approval by the local fire authority.
  • Approval for occupancy shall be obtained from the Department of State Health Services, Architectural Review Group.

Change of Ownership (CHOW) Application

  • A license application form shall be submitted at least 30 calendar days before the date of the change of ownership.
  • A license fee of $14,820.00 shall be submitted. License fees are not refundable.
  • Patient Transfer Documents:
    • A copy of the facility’s Patient Transfer Policy that is in accordance with §131.66 Patient Transfer Policy, and signed by the Chairman and Secretary of the Governing Body shall be submitted.
    • A copy of the facility’s Memorandum of Transfer form that is in accordance with §131.66(b)(9) shall be submitted.
    • A copy of the facility’s Patient Transfer Agreement with a General Hospital that is in accordance with §131.67 Patient Transfer Agreements shall be submitted.
    • Please submit transfer documents to Lisa Peers, RN, BSN, Nurse Consultant, at lisa.peers@dshs.state.tx.us or fax to (512) 834-4514 for approval. Ms. Peers may also be contacted by telephone at (512) 834-6600, extension 2615.
  • A copy of the letter of accreditation by the Joint Commission or another accrediting organization verifying accreditation and the effective date of accreditation.
  • A copy of two completed Fire Safety Survey Report forms shall be submitted. Annual fire safety inspections are required for continued licensure status. Please include a copy of a fire inspection report dated within the last 12 months and a second report dated within the last 13 to 24 months indicating approval by the local fire authority.
  • The applicant or the applicant’s representative shall attend a pre-survey conference at the zone office designated by the department. The designated zone office may waive the pre-survey conference requirement for a Change of Ownership. Please contact the designated zone office to schedule the pre-survey conference or to request a wavier.
  • In addition to the documents required in §131.25 Application and Issuance of Initial License, the applicant shall include evidence (bill of sale, lease agreement, or legal court document) of the change of ownership.

CLIA Information

CLIA information is located on the department’s website. For more information, please contact the zone office for your location.


Survey Components

During the initial licensing period, department zone office staff will conduct an on-site survey to ascertain compliance with the provisions of the Health and Safety Code and associated rules. An entrance conference will be held with key facility personnel. Zone office staff will explain the survey process and answer questions. During the survey, zone office staff will:

  • Review clinical records
  • Review facility policies and procedure
  • Review quality assurance activities
  • Review personnel records
  • Interview staff
  • Conduct an exit conference with key facility personnel
  • Discuss survey findings

Contact Information

The Facility Licensing Group is dedicated to assist you through this process and is available to answer your questions. If you have any questions, please contact the Facility Licensing Group: phone (512) 834-6648, fax (512) 834-4514, email pamela.adams@dshs.state.tx.us or angela.arthur@dshs.state.tx.us.

Mailing Address For Applications With Fees:
Department Of State Health Services
Regulatory Licensing Unit - Facility Licensing Group, Mail Code 2003
P.O. Box 149347
Austin, TX 78714-9347

Overnight Mailing Address For Applications With Fees:
Department Of State Health Services
Facility Licensing Group
Mail Code 2003
1100 West 49th Street
Austin, TX 78756

Last updated October 13, 2016