The following forms and documents are required for rural health clinic (RHC) certification (non-urbanized area). Refer to the primary care clinic (PCC) application details for a list of forms for a RHC to be licensed as a PCC.
In addition to the forms below, you are required to submit additional documents for a change of ownership (if applicable). These documents must be submitted with your completed application. The required information and instructions are listed on the checklist contained in the Certification Request for a Rural Health Clinic (Non-Urbanized Area) webpage.
If already licensed as a PCC, submit the following two (2) forms to the appropriate district office. If NOT licensed as a PCC, submit these two (2) forms to the Centralized Applications Branch.