Welcome to the State of California 

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:


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.

    Last modified on: 7/21/2016 4:51 PM