• Governor
• Secretary
• Director, Division of Health Service Regulation
Page 1 of 2
10/28/2021
LIST OF REQUIRED MATERIALS FOR INITIAL AND CHANGE LICENSURE
Below is a list of materials that are required and must be reviewed by the Mental Health Licensure
Certification Section (MHLC) before a facility is licensed. Fillable Check-sheet
The amount of time it takes to process an application weighs heavily if the licensee is prepared and has all the
necessary material completed for the application process. Therefore, MHLC allows an applicant six months for
licensure. For day programs, six months from the date an application is received. For residential programs, six
months from the date approved from the Construction Section.
Mental Health Licensure requires the licensee to submit their policies and procedures manual
MH Licensure
Policies and Procedures Worksheet must be compl
eted and attached to
with P&P. (The
worksheet is not a substitution for the rules. The licensee is responsible for complying with all applicable
rules and statutes. The information below is only a snapshot of the actual regulations and is not a
substitute for obtaining a licensure rule book)
This includes All personnel working at the facility and with clients. Direct Care, Qualified Professionals, Licensed
Staff's Name and Date of Hire
The Qualified Professional's (QP) and Staff resume or application must be submitted
Verification of Education (Must be official transcripts or diploma)
Licensed Professionals credentials as applicable
Health Care Personnel Registry Verification checks (including the Licensee) Must be completed within
90 days of licensure review
*State/National criminal check documentation
Criminal Check(s) must be completed within 180 days of initial licensure review
CPR Heimlich Maneuver or equivalent. Will not accept if a course if training is online only
Physical and Tuberculosis Screening (per agency policy)
General organization orientation (organization of agency) training
Training in client rights
Training in confidentiality
Training to meet the needs of the population served - based on licensure category (MH/DD/SAS needs)
Training in seizure management
Medication Administration Training (RN, pharmacist or legally qualified person and privileged to administer medications)
Training in infectious Diseases and Bloodborne Pathogens
Training in Alternatives to Restrictive interventions
Training in Seclusion, Physical Restraint and isolation Time Out