HEALTH CARE FACILITY LICENSING AND CERTIFICATION

General Acute Care Hospitals and Acute Psychiatric Hospitals

Change of Location

Required Documents

Online Application PDF Form

Embedded and generated by online system

Location Information

Copy of the Grant Deed, Bill of Sale, Lease, Sublease, or Rental Agreement between the owner of the property and the licensee.

Construction/Other Documentation

Department of Health Care Access and Information (HCAI) Certificate of Occupancy (CO), Construction Final (CF), or Substantial Completion (SC)
STD 850 – Fire Safety Inspection Request (PDF) or a document that contains the fire inspector’s contact information (name, email, and address)
Floor plan that includes a schematic of the room(s)

Facility Information - Medi-Cal Certification Documents: (Only applicable for Medi-Cal Certification)

DHCS 9098 – Medi-Cal Provider Agreement (PDF, 2.9MB)

Helpful Tips

Submit a Change of Certification (CHOC) application to update Medi-Cal/Medicare if applicable.
If the hospital is building a new tower and the main address is changing, submit a Change of Location (CHOL) application. Additionally, the applicant must submit a DHCS 9098 – Medi-Cal Provider Agreement (PDF, 2.9MB) with the updated address.

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