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 Contact Us

Phone: (916) 552-8632

For application status requests, please include the following in your email:

  • Name of Facility or Agency
  • License or Facility/Agency # (if applicable)
  • Address
  • Facility or Provider Type
  • Date Documentation Sent
  • Contact Number​​​​

​​​​General Acute Care Hospitals and Acute Psychiatric Hospitals

Change of Governing Board

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Appointment To the Board Information Organization
  • ​Documents which show appointment to the board
    • ​Corporation – Submit meeting minutes, Articles of Incorporation and By-Laws
    • LLC – Submit meeting minutes, Articles of Organization and Operating Agreement
Licensee/Business Entity Information
  • ​​Organizational chart displaying the following information: applicant’s owners, directors, board members, corporate officers, LLC members/managers, and partners
    • ​​​​​​​The organizational chart prior to the change
    • The organizational chart after the change
Helpful Tip
  • If licensee/entity includes multiple facilities, then only one Change of Governing Board (CHGB) application is required from one facility.

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