Applications for Licensing and/or Certification of a Health Care Facility or Agency

Licensing Fees:

Adult Day Health Center:

• To assist you in preparing your application package:
  Adult Day Health Center Application Request Letter and Instructional Checklist (PDF)

• Application details for an Adult Day Health Center

Ambulatory Surgical Center:

• To assist you in preparing your application package:
  Ambulatory Surgical Center Application Request Letter and Instructional Checklist (PDF)

• Application details for an Ambulatory Surgical Center

Chronic Dialysis Clinic (End Stage Renal Disease):

• To assist you in preparing your application package:
  Application Request for a Chronic Dialysis Clinic and Instructional Checklists

• Application details for a Chronic Dialysis Clinic (End Stage Renal Disease)

Congregate Living Health Facility:

• To assist you in preparing your application package:
  Congregate Living Health Facility Application Request Letter and Instructional Checklist (PDF)

• Application details for a Congregate Living Health Facility

General Acute Care Hospital:

• To assist you in preparing your application package:
  Application Request for a General Acute Care Hospital and Instructional Checklists

• Application details for General Acute Care Hospitals

• Pharmacy Clean Room and Sterile Compounding Checklist (PDF)

Home Health Agency:

• To assist you in preparing your application package:
  Application Request for a Home Health Agency and Instructional Checklists
• Application details for a Home Health Agency
• Criminal Record Clearance Submissions CDPH 325 (PDF)

Hospice:

• To assist you in preparing your application package:
• Application Request for a Hospice Provider and Instructional Checklists 
• Application Request for a Hospice Facility and Instructional Checklists

• Application details for a Hospice

• To assist you in preparing your application package:
  Application Request for Intermediate Care Facilities for the Developmentally Disabled and Instructional Checklists

• Application details for Intermediate Care Facilities for the Developmentally Disabled 

• Criminal Record Clearance Submissions CDPH 325 (PDF)

Management Company - Hospital:

• To assist you in preparing your application package:
  Management Company Application Request Letter and Instructional Checklist - Hospital (PDF)
• Application details for a Management Company - Hospital

Management Company - Skilled Nursing Facility or Intermediate Care Facility:

• To assist you in preparing your application package:
  Management Company Application Request Letter and Instructional Checklist - SNF or ICF (PDF)
• Application details for a Management Company - SNF or ICF

Primary Care Clinics:

• To assist you in preparing your application package:
  Primary Care Clinic Facility Licensing/Certification Application Checklist
• Intermittent Clinic Checklist (PDF)

Rural Health Clinics (Non-Urbanized Area):

• To assist you in preparing your application package:
  Certification Request for a Rural Health Clinic and Instructional Checklists
• Application details for Rural Health Clinics (Non-Urbanized Area)

Skilled Nursing Facilities or Intermediate Care Facilities:

• To assist you in preparing your application package:
  Skilled Nursing Facility or Intermediate Care Facility Application Request Letter and Instructional Checklist
• Application details for a Skilled Nursing Facilities or Intermediate Care Facilities