Ambulatory Surgical Centers Application Package
The applications package for the Ambulatory Surgical Center must include all documents listed in the chart below. The Department reviews each application package and determines an applicant's eligibility for a license.
Specific instructions are provided within each form below.
Ambulatory Surgical Center Licensure Application Form [PDF]
Application Information Documents
DC Ownership and Disclosure Form [PDF]
Clean Hands Act of 1996 Certification Form [PDF]