The following forms and documents are required for rural health clinic (RHC) certification (non-urbanized area). Refer to the primary care clinic (PCC) application details for a list of forms for a RHC to be licensed as a PCC.
In addition to the forms below, you are required to submit additional documents for a change of ownership (if applicable). These documents must be submitted with your completed application. The required information and instructions are listed on the checklist contained in the Rural Health Clinic (Non-Urbanized Area)Certification Request Letter and Instructional Checklist letter.
If already licensed as a PCC, submit the following two (2) forms to the appropriate district office. If NOT licensed as a PCC, submit these two (2) forms to the Centralized Applications Unit.
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