Primary Care Clinic - Affiliate
Application Instructions for Change of Certification
To request and submit changes to a licensed facility in California, complete the required application forms and submit them with all the identified supporting documents. The Centralized Applications Branch (CAB) will not process incomplete applications.
These instructions assist in preparing a Free Community Clinic (COMTYC-FREEC) report of change application packet for a Change of Certification (CHOC).
Please read each required application form carefully and:
- Provide all requested supporting documents
- Retain a copy of the completed application forms and supporting documents – CAB may contact the applicant and will refer to the information provided
Review Process
CAB receives an application packet and assigns an application ID number in the Electronic Licensing Management System. A CAB analyst reviews the application packet to validate receipt of all the required forms and supporting documents. Application packets missing forms and/or supporting documents are incomplete and may result in a delay in processing.
Submission of Applications
Submit completed application packets to:
California Department of Public Health
Licensing and Certification Program
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377
If you have any questions, please contact CAB at (916) 552-8632 or by e-mail at
CAB@cdph.ca.gov.