Health Care Facilities
Paper Application Packet

The Centralized Applications Branch (CAB) is primarily responsible for processing licensing and certification applications for health care facilities and providers. An application packet is required for any of the following:

• Initial (new) facility or agency
• Change of Ownership
• Report of Change 

CAB processes applications in the order in which they are received. Processing times for applications and other Report of Changes vary widely due to complexity of application or reported change. CAB will notify applicants with contact information once an analyst is assigned to process the application.

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.

Video Tutorials

For visual instructional assistance on how to complete specific application forms, please visit the following links:

• Licensure & Certification Application Form (HS 200)
• Applicant Individual Information (HS 215A)
• Application for Medi-Cal Certification as a Primary Care Clinic Provider (HS 269)
• Administrative Organization Form (HS 309)
• Affidavit Regarding Patient Money Form (HS 400)
• Surety Bond Verification (HS 402)
  
• Transfer Agreement Form (HS 602)
• Medically Underserved or Health Professional Shortage Areas (HS 610)
  
• Certification Form for Clinics and Freestanding Outpatient Clinic Services of a Hospital (CDPH 270)
• Transmittal Application for Criminal Record Clearance (CDPH 322)
• Criminal Record Clearance Submissions (CDPH 325)
  
• Bed or Service Request Form (CDPH 609)
• Client Accommodations Analysis Form (CDPH 709)
  

Helpful Resources

• Ambulatory Surgery Center - FAQ (PDF) 
  

• CDPH 270 - Certification Form for Clinics and Freestanding Outpatient Clinic Services of a Hospital (PDF) NEW*
  

• Guide to Accessing Application Packet from CDPH Website (PDF)
  

• Hospice Moratorium AFL
  

• Primary Care Clinic - FAQ (PDF)