Licensing and Certification
Mobile Health Evaluation and Screening Provider

This page contains information and forms required to register as a Mobile Health Evaluation and Screening Provider in Minnesota. These forms are intended to be downloaded and completed by individuals and organizations seeking to be registered as a Mobile Health Evaluation and Screening Provider, or renew a current registration.

• Required Forms and Documents
• Registration Renewal
• Related Statutes and Rules

Required Forms and Documents

• Registration Application to Operate a Mobile Health Evaluation and Screening Provider (PDF): Complete and submit this form to apply for an initial registration or renew an existing registration.

Registration Renewal

Mobile Health Evaluation and Screening registrations are renewed annually. Registrants will receive a renewal notification approximately 60-90 days prior to the expiration date of the registration. If you do not receive a renewal notification within 30 days of the expiration date, please contact Health.HRD-FedLCR@state.mn.us.

• Registration Application to Operate a Mobile Health Evaluation and Screening Provider (PDF): Complete and submit this form with payment to renew an existing registration.

The completed application and supporting documents can be mailed to:

Minnesota Department of Health
Health Regulation Division
P.O. Box 64900
St. Paul, MN 55164-0900

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Related Statutes and Rules

Read and understand all applicable statutes and rules listed below before submitting the application.

• Minnesota Statutes 144.077 - Mobile Health Care Providers 

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