The Department of Public Health, Licensing and Certification (L&C) Program, is notifying specific health facilities noted above, that L&C’s website is available to obtain Initial or Change of Ownership (CHOW) licensure/certification application forms for the following facility types:
Adult Day Health Care (ADHC) Centers
General Acute Care Hospitals (GACH)
L&C’s health facilities forms website address is:
For each ADHC and GACH category, the website includes the fee required, a facility application request letter and instructional checklist to assist you in preparing your application package and the required forms. The forms cannot be saved when the data has been typed in the form. Print completed form and make a copy of each form for your files. Once you have completed all the required forms, submit the required fee, forms and any attachments to the appropriate L&C district office. If you have any questions, contact the appropriate district office as noted on the application request letter. A list of district offices and appropriate contacts are located on the L&C website at:
District Office Contact
If you have any questions, contact Elena Marquez, Acting Chief, Centralized Applications Unit, at (916) 552-8756 or firstname.lastname@example.org.
Original Signed by Kathleen Billingsley, R.N.
Kathleen Billingsley, R.N.