Primary Care Clinic - Intermittent Clinic
Converting an Existing Primary Care Clinic to an Intermittent Clinic Notification Packet
A licensed Primary Care Clinic (PCC) is required to notify the California Department of Public Health (CDPH), whether it is currently operating an intermittent clinic. An Intermittent clinic is "a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week. An intermittent clinic as described in this subdivision shall, however, meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety," pursuant to Health and Safety Code (HSC) section 1206(h).
To notify CDPH of converting a licensed PCC to an intermittent clinic, you must complete the required notification application packet.
How to Notify CDPH
A provider must submit a completed notification application packet to the Centralized Applications Branch (CAB). The notification application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed. The provider instructions are a resource to guide you through the process. The Sample Notification Application Packet is a visual aid that displays a sample of the completed forms and information contained in the notification application packet.
Please refer to the following links to get started:
Where to Submit Notifications
Submit completed notification application packets to the CAB at the address listed below. Do not send any completed notification 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