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Apply for an Adult Day Health program license

Download, complete, and mail the required forms for your license.

Division of Health Care Facility Licensure and Certification

The Details of Apply for an Adult Day Health program license

What you need for Apply for an Adult Day Health program license

  • An Adult Day Health Program is any entity, however organized, whether conducted for profit or not for profit that:
    • Supports families and other caregivers thereby enabling the participant to live in the community
    • Provides nursing care, supervision, and health related support services in a structured group setting to persons 18 years of age or older who have physical, cognitive, or behavioral health impairments; and
    • Is community-based and non-residential

Applicants for Adult Day Health Program licensure must complete all required documents and any additional documents, as applicable.

How to apply Apply for an Adult Day Health program license

To apply for a license of a new or existing program, use the following forms, as applicable:

  1. Application Checklist (DOC) (required form)
  2. Suitability Form (DOC) (required form)
  3. Program Capacity Form (DOC) (required form)
  4. Clinical Information and Attestation Form (DOC) (required)
  5. HCFRS Enrollment Forms:

Programs must include additional documentation as required or applicable as indicated on the Application Checklist.

Mail all completed forms and attachments to:

Licensing Coordinator
DPH, Division of Health Care Facility Licensure and Certification
99 Chauncy St.
11th Floor
Boston, MA 02111

Contact for Apply for an Adult Day Health program license

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