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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 Location

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Location Information 
  • ​Copy of the Grant Deed, Bill of Sale, Lease, Sublease, or Rental Agreement between the owner of the property and the licensee.​
Construction/Other Documentation
  • Department of Health Care Access and Information (HCAI) Certificate of Occupancy (CO), Construction Final (CF), or Substantial Completion (SC) 
  • STD 850 (PDF) form - Fire Safety Inspection Request​ or a document that contains the fire inspector’s contact information (name, email, and address)
  • Floor plan that includes a schematic of the room(s)
Facility Information - Medi-Cal Certification Documents: (Only applicable for Medi-Cal Certification)
  • DHCS 9098 (PDF) form – Medi-Cal Provider Agreement ​
Helpful Tips
  • Submit a Change of Certification (CHOC) application to update Medi-Cal/Medicare if applicable.
  • If the hospital is building a new tower and the main address is changing, submit a Change of Location (CHOL) application. Additionally, the applicant must submit a DHCS 9098 (PDF) form with the updated address.

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