AHCA Form 3170 is a state-issued Florida healthcare licensure document administered by the Agency for Health Care Administration. Providers submit this form when applying for a new facility license, completing a renewal, or reporting a change of ownership. It covers regulated facility types such as Multiphasic Health Testing Centers, clinical laboratories, and home health agencies. Accurate completion is required under Florida Statutes Chapter 408, Part II. See also related forms: AHCA Form 1823, AHCA Form 3020, and AHCA Form 3110-1023.
| Question | Answer |
|---|---|
| Form Name | Ahca Form 3170 |
| Form Length | 23 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 5 min 45 sec |
| Other names | ahcaform3170, ahca application form, acha form 3170 2004, ahca observation forms |