End-Stage Renal Disease Dialysis Facility
Initial Application Packet
A dialysis clinic may be certified as an End-Stage Renal Disease (ESRD) facility in California. An ESRD facility is an entity that provides outpatient maintenance dialysis services, or home dialysis training and support services, or both, pursuant to Title 42 Code of Federal Regulations (CFR) section 494.10
To apply for Initial certification, you must complete the required application packet. Refer to 42 CFR Part 494, Subpart A for the Conditions For Coverage For End-Stage Renal Disease Facilities.
How to Apply
An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed to apply for certification. The provider instructions are a resource to guide you through the process. The Sample Application Packet is a visual aid that displays a sample of the completed forms contained in the application packet.
Please refer to the following links to get started:
Application Packet Forms
Where to Submit Applications
Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Licensing and Certification Program
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377