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Applications for Licensing and/or Certification of Chronic Dialysis Clinic or End-Stage Renal Disease

A chronic dialysis clinic provides less than 24-hour care for the treatment of patients with end stage renal disease including renal dialysis services.

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.  Opens a new browser window

Chronic Dialysis Clinic

Required Forms to be Licensed:

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

End-Stage Renal Disease

Required Forms to be Certified with Medicare:

 
 
Last modified on: 4/15/2013 2:04 PM