Applications for Licensing and/or Certification of a Health Facility
The following application forms and documents are organized by the facility type. In addition to the listed documents, a check made payable to the “California Department of Public Health” for the applicable licensing fee must accompany the required forms before your application will be processed.
Adult Day Health Center:
Affiliate Primary Care Clinic:
Chronic Dialysis Clinic (End Stage Renal Dialysis):
Congregate Living Health Facility (CLHF):
General Acute Care Hospital:
Home Health Agency:
Hospice:
Intermediate Care Facilities for the Developmentally Disabled:
Management Company - Hospital:
Please submit completed forms to your local Licensing and Certification District Office
Management Company - Skilled Nursing Facility or Intermediate Care Facility:
Primary Care Clinics:
Rural Health Clinics (Non-Urbanized Area):
Skilled Nursing Facilities or Intermediate Care Facilities:
For other facility types not listed above, please contact your local Licensing and Certification District Office to obtain an application to license and/or certify a health facility.