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

AFL 10-02
February 26, 2010

Acute Psychiatric Hospitals
General Acute Care Hospitals
Special Hospitals

Collection of Hospital-Based Outpatient Clinics Providing Primary Care Services Information

Pursuant to Health and Safety Code (HSC) Section 1253.5, the California Department of Public Health (CDPH or Department), Licensing and Certification (L&C) Program, is notifying all acute psychiatric, general acute care and special hospitals that the Department will be collecting information for hospital-based outpatient clinics providing primary care services. On or before July 1, 2010 the Department must post and make available on its website a listing of all outpatient services identified on hospital licenses as a supplemental services in addition to a disclaimer that the information contained in the listing is limited to the information reported to the Department by licensed hospitals.

To ensure accurate information is posted to the Department’s website, the Department requests that hospitals update and submit outpatient clinic service information using the attached form, provided for convenience, which includes the name of the clinic, outpatient clinic type, the actual physical address of the clinic, date clinic began providing service, contact person, phone number and e-mail address of each hospital-based outpatient clinic that provides primary care services (family practice, pediatric, primary care, and rural health clinics).

Upon issuance and renewal of a license, CDPH L&C will identify on the license each hospital-based outpatient clinic, address and type of services provided at each outpatient location owned and operated by the licensed hospitals.

Please complete and mail the attached form by May 1, 2010 to:

California Department of Public Health
Licensing and Certification Program
Centralized Applications Unit
P. O. Box 997377, MS 3402
Sacramento, CA 95899-7377

Failure to provide the requested information by May 1, 2010 will inhibit the Department’s ability to meet the statutory requirements of HSC Section 1253.5. Furthermore, failure to provide accurate information to the Department of services provided by the facility will result in delay or denial of license renewals.

If you have any questions concerning this letter, contact Elena Marquez, Chief of Centralized Applications Unit at (916) 552-8756. \



Original Signed by Kathleen Billingsley, R.N.

Kathleen Billingsley, R.N.
Deputy Director




Sheree Kruckenberg, M.P.A.
California Hospital Association
1215 K Street, Suite 800
Sacramento, CA 95814

Gail Nickerson, President
California Association of RHCs
P.O. Box 2344
Granite Bay, CA 95746

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