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State of California—Health and Human Services Agency
California Department of Public Health

Primary Care Clinic (Community Clinic, Free Clinic)

Licensing Application and Checklist​


The following information and checklist provides directions for completing an application package to request:

  • a state license as “community” or “free” primary care clinic (PCC),
  • certification as a Medicare and/or Medi-Cal provider, and/or
  • reporting changes in clinic information.

Table of Contents

  • Licensure - Application Forms
    • PCC - Establishment of a new (initial)
    • PCC - Change of Ownership (CHOW)
    • PCC - Mobile Clinic
    • PCC - Mobile Clinic CHOW
    • Affiliate Clinic
    • Affiliate Clinic CHOW
    • Affiliate Mobile Clinic
    • Affiliate Mobile Clinic CHOW
    • Consolidated License
    • Consolidated Mobile Clinic


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