Cal. Code Regs. Tit. 22, § 71107 - Content of Application
(a) Any person, firm, partnership,
association, corporation, political subdivision of the State, state agency or
other governmental agency desiring to obtain a license shall file with the
Department an application on forms furnished by the Department. The application
shall contain the following:
(1) Name of
applicant, and if an individual, verification that the applicant has attained
the age of 18 years.
(2) Type of
facility to be operated and types of services for which approval is
requested.
(3) Location of the
hospital.
(4) Name of person in
charge of the hospital.
(5) If the
applicant is an individual, satisfactory evidence that the applicant is of
reputable and responsible character.
(6) If applicant is a firm, association,
organization, partnership, business trust, corporation or company, satisfactory
evidence that the members or shareholders thereof and the person in charge of
the hospital for which application for license is made are of reputable and
responsible character.
(7) If the
applicant is a political subdivision of the State or other governmental agency,
satisfactory evidence that the person in charge of the hospital for which
application for license is made is of reputable and responsible
character.
(8) If the applicant is
a partnership, the name and principal business address of each
partner.
(9) If the applicant is a
corporation, the name and principal business address of each officer and
director of the corporation; and for nonpublic corporations the name and
business address of each stockholder owning five percent or more of the stock
and any corporate member who has responsibility in the operation of the
hospital.
(10) Copy of the current
organizational chart.
(11)
Certificate of Need or a Certificate of Exemption from the Department if
required by Chapter 1, Division 1, Division 7 of this title.
(12) Such other information or documents as
may be required by the Department for the proper administration and enforcement
of the licensing law and requirements.
Notes
2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11).
3. Amendment of subsection (a)(11) filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22).
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.