In addition to the forms below, you are required to submit additional documents for a change of ownership (CHOW) plus information regarding your Business Plan. These documents must be submitted with your completed application. The required information and instructions are listed on the checklist contained in the “Chronic Dialysis Clinic (End-Stage Renal Disease) Application Request Letter and Instructional Checklist” letter.
Required Forms to be Licensed:
Required Forms to be Certified with Medicaid/Medi-Cal:
Required Forms to be Certified with Medicare:
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