Home Medical Oxygen Provider


License Information

Fee Reduction

Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee.  Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.

Per Wis. Stat. § 450.076, the required renewal date for the Medical Oxygen Provider credential is 05/31/even years.  Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.

Effective May 1, 2015, all providers of home medical oxygen must be licensed by the Department (§450.076). 

In order to obtain a Home Medical Oxygen Provider license, an applicant must be  accredited by an approved organization (see the application below for a list of approved organizations).


Application for Licensure

FormDescription
3075Application For Home Medical Oxygen Provider
​3217​Application for Fee Reduction (This form must accompany the application for the credential)
​3085​Application for Predetermination (Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.)​
2252​Convictions and Pending Charges
3071​Fax Payment Form

Renewal Information

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG (Signature regarding the Accrediting Organization)

Important Notice:  Please check the DSPS website for the latest rule changes. (Follow the Statutes and Administrative Code link in the sidebar.)

Renewal Methods

FormDescription
RDAFRenewal Dates and Fees
R210​​Active Duty/Discharge Renewal Extension Form

Wisconsin Act 210 (effective June 1, 2012)

This Act extends the license of a service member if the license expires while they are on active duty from 90 days to 180 days from the date of discharge. The same applies to a spouse of a service member if the spouse does not practice under their license while the service member is on active duty and does not practice because the service member is on active duty.

This Act repeals a provision of prior law that required a service member to meet all of the requirements for license extension or renewal, except for continuing education requirements, in order to have the license extended.

Service members and spouses may request extensions of licenses beyond 180 days from discharge and may request a waiver or extension of time to complete continuing education requirements due to hardship. Please view Active Duty/Discharge Renewal Extension Form #R210.