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

AFL 21-31.1
October 6, 2022

General Acute Care Hospitals

Visitor Limitation Guidance at General Acute Care Hospitals (GACHs)
(This AFL supersedes AFL 21-31 and AFL 20-38.7)

All Facilities Letter (AFL) Summary

  • This AFL consolidates the California Department of Public Health's (CDPH's) visitation guidance into a single set of recommendations for GACHs.
  • Skilled nursing facilities should continue to refer to AFL 22-07.1, and the various kinds of intermediate care facilities should continue to refer AFL 21-14.2.
  • This AFL revision announces that, effective September 17, 2022, the visitation requirements outlined in the August 26, 2021 Public Health Order (PHO) are rescinded. Visitors are no longer required to show proof of vaccination or a negative test to have indoor visitation. Visitors must continue to comply with CDPH Masking Guidance while visiting in indoor healthcare settings and should continue to maintain all current infection prevention practices to continue protecting these most vulnerable populations. 


Since the start of the pandemic, CDPH has led with science and data to better understand COVID-19. California has seen a dramatic increase in the percentage of Californians that are fully vaccinated and boosted. At present, 80 percent of Californians 12 years of age and older have completed their primary series of COVID-19 vaccines, and 48 percent have received their first booster dose. Vaccines for children 5-11 years of age have been available since October 2021.

The Omicron subvariants have shown immune escape and increased transmissibility, and while unvaccinated individuals still have higher risk of infection, previously infected, vaccinated, and boosted persons have also been infected. Consequently, mandated testing of unvaccinated visitors is not effectively preventing disease transmission as with the original COVID-19 virus and prior variants earlier in the pandemic. 

On August 11, 2022 and August 24, 2022, the Centers for Disease Control and Prevention (CDC) issued updated guidance, indicating that screening testing is no longer recommended in general community settings; therefore, in accordance with the PHO rescinded September 15, 2022, and effective September 17, 2022, the indoor visitation requirements for GACHs are rescinded. Visitors no longer need to provide proof of vaccination or show documentation of a negative SARS-CoV-2 test when visiting. Visitors must continue to comply with CDPH Masking Guidance while visiting in indoor settings and should continue to maintain all current infection prevention practices to continue protecting these most vulnerable populations. 


CDPH recommends that hospitals allow all patients to have visitors without restriction  provided physical distancing can be accomplished and visitors comply with hospital visitor guidelines.

In addition, CDPH recommends hospitals allow at least two visitors or support persons not necessarily from the same household at the same time, provided physical distancing can be accomplished, for specific patient groups to ensure support for their mental health and well-being:

  • Pediatric Patients
  • Labor and Delivery Patients
    • In addition to the support person(s), CDPH recommends that a doula, if desired by the patient, be permitted to be present if prior arrangements have been made with the hospital and the doula complies with hospital PPE and infection control guidelines.
  • Patients at End-of-Life
  • Patients with Physical, Intellectual, and/or Developmental Disabilities and Patients Cognitive Impairments
  • Surgery Patients

Visitors do not need to be designated in advance by the patient.

Each visitor, regardless of their vaccination status, should be screened for fever and COVID-19 symptoms; CDPH requires all visitors to comply with the CDPH Masking Guidance and wear a well-fitting face mask at all times in the facility including when in the patient's room regardless of vaccination status unless eating or drinking; must wear other personal protective equipment (PPE) as appropriate while in the patient's room; and must physically distance from healthcare personnel and other patients/residents/visitors that are not part of their group at all times while in the facility. Facilities should also limit visitor movement in the facility. For example, visitors should not walk around in hallways of the facility and must go directly to and from the patient's room.

CDPH supports efforts to ensure that new nurses and other professionals coming into the healthcare workforce are able to obtain necessary clinical experience. CDPH encourages students obtaining their clinical experience be permitted to enter the facility if they meet the CDC guidelines for healthcare workers to maintain the workforce needed during this pandemic. Hospitals may allow volunteers in the facility in compliance with their internal policies.

Additionally, CDPH strongly encourages acute care facilities to create ways for patients to have frequent video and phone call visits. If shared devices are used for video calls facilities should ensure appropriate infection control measures are in place. For additional visitation guidance applicable to SNFs, please see AFL 22-07.1 and for guidance applicable to the various kinds of ICF/DD facilities please see AFL 21-14.2.

If you have any questions about this AFL, please contact your local district office.


Original signed by Cassie Dunham

Cassie Dunham

Deputy Director



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