The California Department of Health has issued a new All Facilities Letter (AFL) regarding the revised Applicant Individual Information HS 215A form. Effective immediately, all facility types must use the updated form for initial and change of ownership (CHOW) application packages. The form must also be completed for disclosure purposes when changes are reported, such as changes in administrators, partners, trustees, or corporate officers. The revised form can be obtained from the Licensing and Certification (L&C) Centralized Applications Unit (CAU) website. Skilled nursing facilities, intermediate care facilities, and primary care clinics are among the facilities affected by this change. Non-compliance may result in penalties or other consequences. For questions or concerns, contact Lisa Hall, Chief of the Centralized Applications Unit.

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