Application Forms & Publications

File Nursing Home Administrator
Application Form
Link Address/Name Change/Duplicate License Request
Application Fillable Form
File Nursing Home Administrator - Inactivation Application
Application Fillable Form
File Nursing Home Administrator - Reactivation Application
Application Fillable Form
Link Abandoned Application Important Notice and FAQ's
Pursuant to ยง436B-9, Hawaii Revised Statutes, your application shall be considered abandoned and shall be destroyed if you fail to provide evidence of continued efforts to complete the licensing process for two consecutive years.
Folder NURSING HOME ADMINISTRATOR RENEWAL APPLICATION FORMS
Forms to be used only for renewal and restoration of license.
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Licensing Administrator

Celia Suzuki