Skip to main content

Electronic Forms and Instructions

Instructions: The following instructions are provided as guidance documents on several topics and applications/forms.

Application Information and Instructions
EPCI Q&A
Review Standard Instructions
Supplemental Finance Instructions

Special Notices:

  • A letter of intent must be submitted and processed separately prior to filing an application.
  • The Department no longer requires a separate certification form to be submitted with each application. Applicants are now required to confirm their certification and agreement to abide by the applicable Project Delivery Requirements in their direct responses to each assigned standard. Applicants filing paper applications should respond, as online filers do, by stating after each applicable Project Delivery Requirement section with the following statement, "As the authorized agent, I certify that the applicant will abide by the agreements and assurances required by this Section."

Electronic Forms: The following electronic forms are available for filing letters of intent, applications, emergency applications, amendments, and required progress reports for approved projects. The The Department encourages online filing of letters of intent, nonsubstantive, substantive, and emergency applications, and amendments through the CON e-Serve Application via the MILOGIN system (applications subject to comparative review must be filed in paper format).

For paper filings or paper forms still required with an electronic filing, please download the required form each time you need to use it. Outdated forms will not be accepted.

Form No. Title
Metro, Micro Statistical, and Rural Counties
CON-004 Non-Substantive Routing Record - 07/16
CON-005 Substantive & Comparative Routing Record - 02/20
CON-100 Application for CON - All Applicants - 07/16
CON-100 Instructions Application Information and Instructions - 07/16
CON-101 Application for Emergency Certificate of Need - 07/16
CON-105 Project Summary - 07/16
CON-110-A Acquisition of Licensed Health Facility - 04/15
CON-110-B Bed Replacement/Relocation Report -04/15
CON-110-C Mobile Host Site - 04/15
CON-110-D Acquisition, Replacement or Relocation of a Covered Clinical Service - 04/15
CON-110-F Finance Report - 04/15
CON-110-i Application for Change in Mobile Host Site-07/16
CON-113 Application for Swing Beds - 02/21
CON-144 Amended Request for CON -07/16
CON-145 Effective Dates of Standards - 09/21
CON-146 Expedited Processing Request - 06/18
CON-148 Projects Eligible for Non-Substantive Review - 05/18
CON-149 Letter of Intent - 07/16(Online VIA MILogin)
CON-200 Section 22225 Excerpts of PA 368 of 1978 - 02/17
CON-200-A Review Standards Instructions-07/16 
CON-200-C Certification of Planning Area-Bed Need - 09/19
CON-202 Lithotripsy Standards - 11/12/2019
CON-204 NICU Standards - 03/19/2021
CON-205 Psychiatric Beds Inpatient Standards - 11/12/2019
CON-206 Surgical Standards - 12/22/14
CON-208 Open Heart Surgical Standards - 06/02/2014
CON-209 Heart/Lung/Liver Transplant Standards - 09/28/2012
CON-210 Cardiac Catheterization Standards - 09/14/2015
CON-210-B Request for Change to Interventional Cardiologist - 04/18
CON-210-C Historical Utilization Report AMI Cases Eligible for Primary PCI - 04/15
CON-210-D Historical Utilization Report Interventional Cardiologist Cases - 02/16
CON-210-E Projection of Elective PCI Cases - 09/21
CON-210-F Elective PCI Commitment Form Interventional Cardiologist Cases - 09/15
CON-210-G Cardiac Catheterization Commitment Form - 09/21
CON-210-G(2) Cardiac Catheterization Commitment Form-Facility (Same Applicant) - 09/21
CON-210-H Cardiac Cath Commitment Form-CIED - 09/21
CON-210-H(2) Cardiac Cath Comittment Form CIED-Facility (Same Applicant) - 09/21
CON-211 MRT Standards - 09/14/2015
CON-212 CT Scanner Standards - 12/09/2016
CON-213 MRI Standards - 10/21/2016
CON-214 Hospital Beds Standards - 03/20/2015
CON-217 NH-HLTCU Bed Standards - 03/19/2021
CON-217-A NH-HLTCU Certification Report - 9/08
CON-217-B NH-HLTCU Culture Change Model Worksheet - 02/18
CON-219 Physician Commitment for MRI - 10/19
CON-220 Physician Commitment for MRI Procedures - 04/15
CON-220-A Certification for Referring Doctor Commitment of Avail. MRI Adj.Procedures - 04/15
CON-222 OH Surgery MIDB Data Release Authorization and Verification Form - 02/20
CON-226 Pancreas Transplantation Standards - Deregulated 09/28/2012
CON-227 PET Scanner Standards - 09/14/2015
CON-228 Air Ambulance Standards - 06/02/2014
CON-229 Bone Marrow Transplantation Standards - 09/29/2014
CON-230-A Lithotripsy Data Release Authorization - 10/15
CON-300 Project Description - 07/16
CON-600 Project Personnel Need - 07/16
CON-602 MRT Staffing Report - 04/15
CON-700 Inpatient Bed Utilization Report - 04/15
CON-704 Surgical Utilization Report - 04/15
CON-704-A Surgical Physician Commitment - 04/15
CON-704-F Surgical Commitment Form for Facility (Same Owner) - 01/18
CON-706 CT Utilization Report - 10/21
CON-706-A CT Physician Commitment - 02/21
CON-707 MRT Utilization Report - 01/20
CON-707-A MRT Governing Body Resolution - 10/21
CON-707-B MRT Physician Commitment-8/17
CON-715 Lithotripsy Utilization Report - 04/15
CON-716 Cardiac Catheterization Utilization Report - 12/18
CON-720 Hospice Days of Care Report - 07/16
CON-732-A PET Utilization Report - 04/15
CON-733 PET Data Verification - 07/16
CON-733-A PET Sample of Governing Body Resolution for Submission of Data Commit. - 04/15
CON-733-B PET Withdrawal of Data Commitments - 07/16
CON-800 Physical Design Project Report - 04/15
CON-801 Facility Area Report - 07/16
CON-802 LTC Physicial Design Report - 07/16
CON-803 Facility Area Report LTC - 04/15
CON-804 Physical Design Report -07/16
CON-1000 Equipment Report - 07/16
CON-1001 Major Equipment Report - 04/15
CON-1100 General Financing Questions - 07/16
CON-1105 Grants and Appropriations - 07/16
CON-1108 Hospital Utilization Statistics - 07/16
CON-1110 Hospital 5-Year Revenue & Expense Report - 07/16
CON-1114 NH Statement Revenue and Expense - 07/16
CON-1118 Revenue and Expense Statement Other - 07/16
CON-1200 Financed Projects - 07/16
CON-1202 Debt Service Coverage - 07/16
CON-1203 Amortization - 07/16
CON-1300 Project Implementation Progress Report - 08/16
CON-1400 Special Care Nursery (SCN) Follow-Up - 08/16
 
 

State of Michigan
Department of Health & Human Services - Certificate of Need Program
South Grand Building, 333 S. Grand Avenue, P.O. Box 30195
Lansing, MI 48909

Your questions and comments regarding our website are welcome.
Send them to us via CON WebTeam.
Updated April 29, 2022