Acute Psychiatric Hospital
Change of Name Application Packet
Per AFL 19-41 (PDF), please be advised that as of July 2, 2020, CAB will ONLY accept GACH/APH online applications and will no longer accept and/or process GACH/APH paper applications received after July 1, 2020. Refer to the Online GACH/APH Application web page for additional information or contact CABHospitals@cdph.ca.gov.
*Exceptions: Elective Percutaneous Coronary Intervention (ePCI), Sterile Compounding, and Change of Management Company (CHMC) applications are only processed as paper applications until further notice.
A State license is required to operate as an Acute Psychiatric Hospital (APH) in California. An APH means "a hospital, having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care for mentally disordered, incompetent or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services", pursuant to Title 22 of the California Code of Regulations (CCR) Section 71005(a).
A verified application shall be forwarded to the Department whenever a change of name of a hospital occurs, pursuant to Title 22 CCR Section 71105.
To report a Change of Name, you must complete the required application packet. Refer to Title 22 CCR Sections 71105, 71107, 71110, and 71125 for information regarding licensure requirements.
How to Apply
An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. The provider instructions are a resource to guide you through the process. 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:
Where to Submit Applications
Please click here to submit an Initial, Change of Ownership, or Report of Change on the GACH/APH online application system. Refer to the Online GACH/APH Application web page for additional information or contact CABHospitals@cdph.ca.gov.
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