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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. 

How to apply for specified health programs simultaneously:

To learn about the process and obtain the forms to simultaneously apply for the following health programs as you apply for a clinic license, please reference the sites and documents below.

Chronic Dialysis Clinic (End Stage Renal Dialysis):

Clinics:

·         Licensing & Certification Program License Fees.Opens a new browser window

·         To assist you in preparing your application package:
Clinic Facility Application Request Letter and Instructional Checklist (PDF)Opens in new window

·         Application details for Clinics

 
Home Health Agency:

·         Licensing & Certification Program License Fees.Opens a new browser window

·         To assist you in preparing your application package:
Home Health Agency Application Request Letter and Instructional Checklist (PDF)Opens a new browser window

·         Application details for a Home Health Agency

 

Intermediate Care Facilities for the Developmentally Disabled:

·         Licensing & Certification Program License Fees.Opens a new browser window

·         To assist you in preparing your application package:
Intermediate Care Facility for the Developmentally Disabled Application Request Letter and Instructional Checklist (PDF)Opens a new browser window

·         Application details for an Intermediate Care Facilities/DD

 

Management Company:

·         To assist you in preparing your application package:
Management Company Application Request Letter and Instructional Checklist (PDF)Opens a new browser window

·         Application details for a Management Company

 

Skilled Nursing Facilities:

·         Licensing & Certification Program License Fees.Opens a new browser window

·         To assist you in preparing your application package:
Skilled Nursing Facility Application Request Letter and Instructional Checklist (PDF)Opens a new browser window

·         Application details for a Skilled Nursing 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.