General Acute Care Hospitals and Acute Psychiatric Hospitals
Change of Services - Mobile Unit(s)
Required Documents
Online Application PDF Form
- Embedded and generated by online system
Addition or Reactivation of Mobile Unit
- Documentation/letter approval from the local planning/zoning agency)
- Department of Health Care Access and Information (HCAI) Certificate of Occupancy (CO), Construction Final (CF), or Substantial Completion (SC) (Not applicable if the pad has previously been approved by HCAI)
- Letter verifying the mobile unit is self-contained (if applicable)
- Copy of Vehicle registration, including ID, type, and manufacturer (Not applicable for modular units)
- Copy of Department of Housing & Community Development (HCD) Insignia or āInspection Approvalā
- STD 850 (PDF)āā form - Fire Safety Inspection Request or a document that contains the fire inspectorās contact information (name, email, and address)
- Schematic displaying the location of the mobile unit on the facility property
Helpful Tip:
- āSubmit a Change of Certification (CHOC) application to update Medi-Cal/Medicare, if applicable.
Replacement of a Mobile Unit
Removal of a Mobile Unit:
- āNo uploaded documentation required