Rehabilitation Clinic
Change of Ownership Application Packet

A State license is required to operate a Rehabilitation Clinic (REHABC) in California. A REHABC means “a clinic that, in addition to providing medical services directly, also provides physical rehabilitation services for patients who remain less than 24 hours. Rehabilitation clinics shall provide at least two of the following rehabilitation services: physical therapy, occupational therapy, social, speech pathology, and audiology services. A rehabilitation clinic does not include the offices of a private physician in individual or group practice,” pursuant to Health and Safety Code (HSC) section 1204(b)(3).

To report a Change of Ownership, you must complete the required application packet. Refer to HSC sections 1200 through 1245 for information regarding licensure requirements.

How to Apply

An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The provider instructions are a resource to guide you through the process. The provider checklist identifies the required forms and supporting documents needed to apply for licensing. 

Please refer to the following links to get started:

• Provider Instructions (PDF)
• Provider Checklist ​
  

Application Packet Forms

Applicants must complete and submit the following forms in the application packet:

• HS 200 - Licensure and Certification Application (PDF, 1.5MB)
• CDPH 270 - Certification Form for Clinics and Freestanding Outpatient Clinic Services of a Hospital (PDF)
• HS 215A - Applicant Individual Information (PDF)
• HS 309 - Administrative Organization and Organizational Structure (PDF)
• STD 850 - Fire Safety Inspection Request (PDF)

Where to Submit Applications

Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.

          California Department of Public Health
          Licensing and Certification Division
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377