HEALTH CARE FACILITY LICENSING AND CERTIFICATION

Contact Us

Phone: (916) 552-8632
Email: CAB@cdph.ca.gov

For application status requests, please include the following in your email:

Online Application PDF Form

Location Information

Copy of the Grant Deed, Bill of Sale, Lease, Sublease, or Rental Agreement between the owner of the property and the licensee.

Construction/Other Documentation

Department of Health Care Access and Information (HCAI) Certificate of Occupancy (CO), Construction Final (CF), or Substantial Completion (SC)
STD 850 (PDF) form - Fire Safety Inspection Request or a document that contains the fire inspector’s contact information (name, email, and address)
Floor plan that includes a schematic of the room(s)

Facility Information - Medi-Cal Certification Documents: (Only applicable for Medi-Cal Certification)

Helpful Tips

Submit a Change of Certification (CHOC) application to update Medi-Cal/Medicare if applicable.
If the hospital is building a new tower and the main address is changing, submit a Change of Location (CHOL) application. Additionally, the applicant must submit a DHCS 9098 (PDF) form with the updated address.

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