Instructions for completing Construction Plan Submittal Form - Minnesota Dept. of Health

Instructions for completing Construction Plan Submittal Form

Project Name–enter project name as it appears on the submittal plans

Date–enter date submittal package is being submitted

Project Narrative–give a description to describe the project/work

Project Address–enter address/city/zip of building where project is happening

HFID#–Health Facility Identification Number can be found at MDH Provider Directory

Facility Information–enter name/address as it appears on facility license

Submitter Information–enter information for individual submitting project and to whom we should direct questions about the project

MDH Staff–If a preliminary review was done, select name of MDH staff member who did review

Project Information–
State License Type:
FOSC – Freestanding Outpatient Surgical Center
HSP – Hospital
NH – Nursing Home
PPEC – Prescribed Pediatric Extended Care Center
RES HOSPICE – Residential Hospice
SLF A – Supervised Living Facility Class Ambulatory
SLF B – Supervised Living Facility Class Non- Ambulatory
SLF A & B – Supervised Living Facility Class Ambulatory & Non-Ambulatory
Off Site Unit of HSP – Facility at a different location from the hospital

Federal Certification Type:
ASC – Ambulatory Surgical Center
CAH – Critical Access Hospital
ESRD – End Stage Renal Disease
HOSPICE – Certified Hospice
HSP – Hospital
ICF/IID – Intermediate Care Facilities for Individuals with Intellectual Disabilities
PRTF – Psychiatric Residential Treatment Facility
SNFNF – Skilled Nursing Facility/Nursing Facility (Nursing Home)

Submit Construction Plan Submittal Form (PDF) along with a certified copy of final construction plans, a writable PDF copy of final certified construction plans and digital specs, as well as a check for fee, payable to: “Commissioner of Finance, Treasury Division” to:

Mail:
MDH Engineering Services Section
ATTN: Plan Review
PO BOX 64900
St. Paul, MN 55164-0900

Courier:
MDH Engineering Services Section
ATTN: Plan Review
85 E 7th Place, Suite 200
St. Paul, MN 55101-2143

Updated Friday, February 01, 2019 at 02:42PM