HEALTH CARE FACILITY LICENSING AND CERTIFICATION

General Acute Care Hospitals and Acute Psychiatric Hospitals

Online Application PDF Form

Addition or Reactivation of Mobile Unit

Documentation/letter approval from the local planning/zoning agency)
Department of Health Care Access and Information (HCAI) Certificate of Occupancy (CO), Construction Final (CF), or Substantial Completion (SC) (Not applicable if the pad has previously been approved by HCAI)
Letter verifying the mobile unit is self-contained (if applicable)
Copy of Vehicle registration, including ID, type, and manufacturer (Not applicable for modular units)
Copy of Department of Housing & Community Development (HCD) Insignia or “Inspection Approval”
STD 850 – Fire Safety Inspection Request (PDF) or a document that contains the fire inspector’s contact information (name, email, and address)
Schematic displaying the location of the mobile unit on the facility property

Helpful Tip

Submit a Change of Certification (CHOC) application to update Medi-Cal/Medicare, if applicable.

Replacement of a Mobile Unit

Letter verifying the mobile unit is self-contained (if applicable)
Copy of Vehicle registration, including ID, type, and manufacturer (Not applicable for modular units)
Copy of Department of Housing & Community Development (HCD) Insignia or “Inspection Approval”
STD 850 – Fire Safety Inspection Request (PDF) or a document that contains the fire inspector’s contact information (name, email, and address)

Removal of a Mobile Unit