Home Care Survey Forms and Self-Audit Tools

Be Prepared for Your Survey

Minnesota home care laws require that the Minnesota Department of Health (MDH) survey licensed home care providers at least once every three years. Temporary licensed home care providers will have an initial full survey during the twelve-month temporary license period. Licensees that undergo a change of ownership will have a full survey within six months of issuance of the new license.

To prepare for a survey, providers can use the forms on these pages. These are the same forms MDH staff use when conducting a survey. Reviewing the forms will help providers and their staffs understand what MDH will look at when they visit.

Forms

Use the forms to:

• Understand the requirements of home care statutes
• Conduct self-audits
• Be ready for an MDH survey

Links to the home care statutes are included throughout the forms to help providers understand state requirements.

Click on the appropriate link below to get started.
Temporary licensed home care providers
Licensed home care providers