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Applications for Licensing and/or Certification of General Acute Care Hospital

The following forms and documents are required for licensure and/or certification as a general acute care hospital (GACH) and to apply for a hospital outpatient clinic.

In addition to the forms below, you are required to submit additional documents for a change of ownership.  Also, please submit proof of GACH accreditation from the Joint Commission of the Accreditation of Healthcare Organizations (JCAHO), American Osteopathic Association (AOS), or the Det Norske Veritas Healthcare, Inc. (DNV), if applicable.  These documents must be submitted with your completed application.  The required information and instructions are listed on the checklist contained in the “General Acute Care Hospital Application Request Letter and Instructional Checklist”   letter.

General Acute Care Hospital

Required Forms to be Licensed:

Required Forms to be Certified with Medicaid/Medi-Cal:   

Required Forms to be Certified with Medicare:

Required Forms for Adding a Hospital Outpatient Clinic:

Required Forms for a Hospital Outpatient (Non-Urbanized Area) Rural Health Clinic to be Certified with Medi-Cal:

Required Forms for a Hospital Outpatient (Non-Urbanized Area) Rural Health Clinic to be Certified with Medicare:

 
 
Last modified on: 8/1/2013 1:12 PM