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Licensing and Certification Program

Certification "Only" of a Rural Health Clinic (Non-Urbanized Area)

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.

Determination of Rural Health Clinic (Non-Urbanized Area) Status

Required Forms to Determine if a Clinic is in a Designated Rural Health (Non-Urbanized) Area:

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.

Rural Health Clinic (Non-Urbanized Area)

Required Forms to be Certified with Medicaid/Medi-Cal:

Required Forms to be Certified with Medicare:

Required Forms if Already a Licensed PCC and Want to be Certified with Medicaid/Medi-Cal as a RHC (Non-Urbanized Area):

Required forms if Already a Licensed PCC and Want to be Certified with Medicare as a RHC (Non-Urbanized Area):

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Contact Us:

Phone: (916) 552-8632

Email: CAB@cdph.ca.gov

Staff will respond to your inquiry within 48 hours.

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