Alternative Birth Center
Change of Ownership Application Packet

A State license is required to operate an Alternative Birth Center (ABC) in California. An ABC means "a clinic that is not part of a hospital and that provides comprehensive perinatal services and delivery care to pregnant women who remain less than 24 hours at the facility," pursuant to Health and Safety Code (HSC) section 1204(b)(4).

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. The Sample Application Packet is a visual aid that displays a sample of the completed forms contained in the application packet.

Please refer to the following links to get started:

• Provider Instructions (PDF)
• Provider Checklist (PDF)
• Sample Application Packet (PDF)

Application Packet Forms

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

• HS 200 - Licensure and Certification Application (PDF)
• 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)
• DHCS 6207 - Medi-Cal Disclosure Statement (PDF)
• DHCS 9098 - Medi-Cal Provider Agreement (PDF)
• HS 328 - Notice of Effective Date of Provider Agreement (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 Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377