Applications for Licensing and/or Certification of Clinics
The following forms and documents are required for licensure and/or certification.
A Clinic Exemption list can be found here
(after clicking link, please click first search result, then scroll to Section 1206).
Community Clinic
To be licensed only:
Community Clinic
To be licensed and certified with Medicaid/Medi-Cal:
Free Clinic
To be licensed only:
Free Clinic
To be licensed and certified with Medicaid/Medi-Cal:
Mobile Clinics
To be licensed as a Primary Care Clinic (Community Clinic or Free Clinic)
Mobile Clinics
To be licensed and certified with Medicaid/Medi-Cal:
Rural Health Clinic
In addition to the rural health clinic forms below, please provide a Census Track Number for the address of the clinic. This information can be obtained by contacting the County Planning Department in which the clinic is located. Note: If applicable, please attach any documentation from the Office of Shortage Area. (Documentation must be current and must include the address of the clinic for which you are applying.)
To be licensed as Primary Care Clinic and certified with Medicaid/Medi-Cal/Medicare: