New CA HMDR Application Forms Take Effect

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Updated June 28, 2023

The contact phone numbers in the original post changed: 

If you look at the Exemptee application, it states, "If you have any questions, please contact the Home Medical Device Retailer Exemptee Licensing Desk at (916) 650-6500, (800) 495-3232."

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New California Home Medical Device Retailer (HMDR) Applications Forms - (click this link)

• Facility application forms
• Exemptee application form

If you're looking to submit a facility or Exemptee license application, be sure you're choosing the correct form.  The HMDR home page (at the time of writing) posts the soon to expire "outgoing" forms, and the soon to become effective "incoming" application forms.

If you have questions about which version to submit, you might want to reach out to the HMDR office.  For example, if you look at the new Exemptee application, it states, "If you have any questions, please contact the Home Medical Device Retailer Exemptee Licensing Desk at (916) 341-7354, (800) 495-3232."

Where Can I Download HMDR License Application Forms?

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Download HMDR License Application Forms

For California Home Medical Device Retailers (HMDR)

There is a CDPH HMDR webpage that links to the current application forms for both the firm license application(s) needed by each individual facility location where home medical devices (prescription Rx devices and non prescription devices) will be sold, leased or rented when ordered by a physician or other prescriber.

The application for the HMDR Exemptee is also linked on the webpage for firms who wish to sell prescription Rx devices such as respiratory equipment, medical oxygen and other equipment identified as dangerous or legend devices under California law.

These forms can be filled out online using the Adobe reader but must be printed out, signed and returned to the license desk to complete the license application process.

Source:
CDPH Home Medical Device Retailer (HMDR) Certificates and Licenses

You might also be interested in:
The California Exemptee Certification Class - CDPH-accepted training for home medical device retailer (HMDR) Exemptee license applicants

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