Revised 9/15/14
BUILDING DIVISION
2013 California Building Code
OSHPD 3 CLINICS
INSPECTION GUIDELINES
INDEX
Determine Applicability of OSHPD 3, Flowchart
Plan Review Checklist
Inspection Guidelines
PAGE
1
13
21
1
Facilities Development Division
Office of Statewide Health Planning and Development
400 R Street, Suite 200 • Sacramento, CA 95811 • (916) 440-8300
700 N. Alameda Street, Suite 2-500 • Los Angeles, CA 90012 • (213) 897-0166
SUBJECT
Clinics
CODE APPLICATION NOTICE (CAN)
H&S Code §129851
CAN:
1-7-2100
Effective:
Revised:
6/19/2008
3/3/2014
CODE SECTIONS
Article 21, Chapter 7
California Administrative Code (CAC)
Article 21 - Plan Review, Building Inspection and Certification of Surgical Clinics, Chronic
Dialysis Clinics and Outpatient Services Clinics
PURPOSE
The determination of which clinics and outpatient facilities are subject to the OSHPD 3
requirements found in Title 24, California Building Standards Code is complex. This results
in a lack of consistency in application of the model code and OSHPD 3 requirements to
clinic facilities, and uncertainty regarding the roles of the local building jurisdiction and
OSHPD in the plan review, certification and construction inspection processes.
Confusion exists, in part, because the use of the generic terms “clinics” and “outpatient
facilities”. The OSHPD 3 requirements found in the code apply only to those clinics and
outpatient facilities that are licensed pursuant to Health and Safety Code (H&SC) Section
1200 or 1250. There are variables in statute and regulations regarding the use and
licensing of these clinic facilities, making consistent application of the regulations complex.
Another source of confusion is that the applicability of certain requirements is determined
by factors that are normally out of the scope of work of the building department and
designer. For example, sources of financial reimbursement and the specific type of license
a clinic owner desires to obtain determine what regulations apply and who has jurisdiction
for the project.
INTERPRETATION
In order to determine the applicability of OSHPD 3 requirements, it is necessary to know if
the clinic facility is licensed, and if so, how it is licensed. OSHPD 3 requirements for clinics
only apply to clinics that are licensed pursuant to H&SC Section 1200 (which includes
primary care clinics and specialty clinics) or H&SC Section 1250 (which includes outpatient
clinical services of a licensed hospital). Where the term “clinic” or “outpatient facility” is
used relative to OSHPD 3 requirements in the California codes, it shall mean a clinic or
outpatient facility licensed pursuant to H&SC Section 1200 or 1250.
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The application of OSHPD 3 requirements is independent of the determination of
occupancy classification. A Group B Occupancy doctor’s office is subject to OSHPD 3
requirements if the office is licensed as a clinic pursuant to H&SC Section 1200.
Conversely, a surgical clinic classified as a Group I-2.1 occupancy is not subject to OSHPD
3 requirements if it is not licensed pursuant to H&SC Section 1200 or 1250.
It should be noted that other requirements, not enforced by OSHPD or the local building
jurisdiction may apply, for example, the NFPA 101 Life Safety Code.
The attached documents are intended to assist local building jurisdictions and designers in
applying OSHPD 3 regulations, and determining which jurisdiction has authority over the
plan review, certification and construction inspection of clinic facilities.

California Medical Clinic Guidelines, Plan Review, Approval, Inspection and
Certification Flowchart. Provides a process to follow in determining the appropriate
authority having jurisdiction and applicable regulations for various clinic facilities.

Flowchart Explanatory Notes. Provides additional information to use in applying the
flowchart.

Appendix. Contains a glossary of terms, identities common acronyms and summary of
roles of agencies involved in the plan review, certification and inspection of clinic
facilities.
Original signed
Paul Coleman
Indicates Revision
3/6/14
Date
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CAN 1-7-2100
CALIFORNIA MEDICAL CLINIC GUIDELINES FOR
PLAN REVIEW, APPROVAL, INSPECTION AND CERTIFICATION
28
1
Is the building intended
to be licensed by
CDPH?
NO
3
31
30
ASC Certified for
Medicare
YES
YES
29
Doctors’ Office
2
3
Local plan review, permit, inspection
and approval to Title 24.
Excludes OSHPD 3.
Local plan review, permit, inspection
and approval to Title 24.
Excludes OSHPD 3.
32
NO
Is the clinic under a CDPH
hospital license?
26
13
5
Nonhospital Building
Freestanding Clinic
(H&SC 1250)
Hospital Building
(H&SC 1250)
CDPH conducts survey for life
safety requirements
NFPA 101 (2000 Edition)
Licensed Freestanding
Specialty Clinic
(H&SC 1200)
14
Licensed Primary Care
Clinic (includes
Community, Free,
Employee & Optometric
clinics) and Psychology
Clinic (H&SC 1200)
24
Rehabilitation Clinic and
Alternate Birthing Center
Chronic Dialysis and
Surgery Clinic
4
OSHPD review and
approval to Title 24
including OSHPD 1
6
25
Owner selects plan
review agency
Local plan review, permit,
inspection and approval
to Title 24 including
OSHPD 3
15
Owner requests plan
review agency
OSHPD
7
OSHPD plan review,
certify, permit, inspection
and approval to Title 24
including OSHPD 3
9
Local Building
Jurisdiction
Will local provide
certification to
OSHPD 3?
12
YES
Freestanding clinic
building remains under
OSHPD jurisdiction until
notified by owner
OSHPD
22
16
OSHPD accepts?
(consult with local)
19
NO
Will local provide
certification to
OSHPD 3?
YES
Local plan review, certify,
permit, inspection and
approval to Title 24
including OSHPD 3
10
YES
OSHPD plan review and
certify to OSHPD 3 only
17
NO
20
OSHPD plan review and
certify to Title 24
including OSHPD 3
11 Local plan review to Title
24 (except OSHPD 3).
Local permit, inspection
and approval to Title 24
including OSHPD 3
18
OSHPD plan review and
certify to OSHPD 3 only
21
Local permit, inspection
and approval to Title 24
including OSHPD 3
NOTE: Compliance with Title 24, California Building Standards Code,
including OSHPD 3 provisions, is required unless otherwise noted.
Revised 3/3/14
Local plan review, permit,
inspection and approval
to Title 24 including
OSHPD 3
Local Building Jurisdiction
Local plan review,
certify, permit,
inspection and approval
to Title 24 including
OSHPD 3
NO
8
27
Page 3 of 12
Local plan review to Title
24 (except OSHPD 3).
Local permit, inspection
and approval to Title 24
including OSHPD 3
23
CDPH conducts survey
for Surgical and Dialysis
Clinics only
NFPA 101 (2000 Edition)
CAN 1-7-2100
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CODE APPLICATION NOTICE (CAN)
California Medical Clinic Guidelines
Plan Review, Approval, Inspection and Certification
Flowchart Explanatory Notes (Keyed to numbers at upper left corner of each box on flowchart.)
Citations are from the Health and Safety Code (H&SC) and the California Administrative Code
(CAC) Chapter 7.
1.
If the clinic is not licensed by California Department of Public Health (CDPH), Licensing and
Certification, compliance and certification to the requirements of OSHPD 3 are not required.
2.
How a clinic is licensed will affect which sections Title 24, California Building Standards Code
apply, how they are applied and what agency (local building jurisdiction or OSHPD) will
enforce them.
3.
“Hospital building” is defined in H&SC Section 1250. OSHPD preempts the local building
jurisdiction for enforcement of the Title 24, California Building Standards Code.
4.
Hospital buildings are subject to OSHPD jurisdiction and must comply with OSHPD 1
requirements in the CBC.
5.
Freestanding clinic buildings under the hospital license are typically subject to the local
building jurisdiction, although they are licensed under H&SC Section 1250.
6.
The owner or governing authority may submit plans directly to the local building jurisdiction or
may select OSHPD to perform the plan review and certification for freestanding hospital
outpatient clinics. (Also refer to OSHPD Code Application Notice (CAN) 1-6-1.4.5.1.4,
“Removal of Acute Care Services”.)
7.
If the governing authority selects OSHPD to perform the plan review and certification
responsibilities for a freestanding hospital licensed outpatient clinic, then the entire project,
including plan review and approval to Title 24 including OSHPD 3 requirements, building
permit and construction inspection is under OSHPD jurisdiction.
8.
Freestanding clinic buildings that have been reviewed by OSHPD will remain under the
jurisdiction of the Office until the owner or governing authority notifies OSHPD otherwise in
writing.
9.
Written certification of compliance to OSHPD 3 is required for outpatient clinical services of a
hospital including surgical clinics and dialysis clinics. If plans are submitted to the local
building jurisdiction, the local building jurisdiction must notify the owner or governing authority
if their review will include written certification for OSHPD 3 conformance.
10. If the local building jurisdiction will not provide written certification to OSHPD 3 requirements,
then plans shall be submitted to OSHPD for plan review and certification to OSHPD 3
requirements only. The local building jurisdiction shall review the plans for compliance to
Title 24 excluding OSHPD 3.
11. Concurrent with OSHPD’s review to OSHPD 3 requirements, the local building jurisdiction
reviews the plans for compliance to Title 24, except OSHPD 3. The design professional of
record is required to coordinate the OSHPD certification documents with those permitted by
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CODE APPLICATION NOTICE (CAN)
the local jurisdiction. The local building jurisdiction shall also issue the building permit and
perform construction inspection to Title 24 including OSHPD 3 requirements.
12. If the local building jurisdiction will provide written certification to OSHPD 3 requirements, then
the entire project, including plan review and approval, building permit and construction
inspection for the project is under the local building jurisdiction.
13. Licensed freestanding specialty clinics are defined in H&SC Section 1200. Specialty clinics
include surgical, chronic dialysis, and rehabilitation clinics and alternate birthing centers. All
specialty clinics are required to conform to the requirements of OSHPD 3.
14. Written certification to OSHPD 3 is required for licensed surgical and dialysis specialty clinics
and only these specialty clinics may be reviewed and certified by OSHPD.
15. The owner or governing authority must submit plans directly to the local building jurisdiction or
may request OSHPD to perform the plan review and certification for surgery and dialysis
specialty clinics.
16. OSHPD must consult with the local building jurisdiction, and either accept or not accept the
clinic project for plan review. One purpose for this consultation is to determine whether or not
the local building jurisdiction will issue a building permit and inspect construction for a project
for which OSHPD did the plan review. If the local building jurisdiction is unwilling or unable to
do this, OSHPD cannot accept the review.
17.
If, after consultation with the local building jurisdiction, OSHPD accepts the project for plan
review, then OSHPD must perform a complete plan review of Title 24 requirements, including
OSHPD 3. The local building jurisdiction is not involved in plan review.
18. The local building jurisdiction must issue the building permit and perform construction
inspection to Title 24 including OSHPD 3.
19. If plans are submitted to the local building jurisdiction, the local building jurisdiction must notify
the owner or governing authority if their review will include certification for OSHPD 3
conformance.
20. If the local building jurisdiction will not provide written certification to OSHPD 3 requirements,
then plans shall be submitted to OSHPD for plan review and certification to OSHPD 3
requirements only. The local building jurisdiction shall review the plans for compliance to
Title 24 excluding OSHPD 3.
21. Concurrent with OSHPD’s review to OSHPD 3 requirements, the local building jurisdiction
reviews the plans for compliance to Title 24, except OSHPD 3. The design professional of
record is required to coordinate the OSHPD certification documents with those permitted by
the local jurisdiction. The local building jurisdiction shall also issue the building permit and
perform construction inspection to Title 24 including OSHPD 3.
22. If the local building jurisdiction will provide written certification to OSHPD 3 requirements, then
the entire project, including plan review and approval, building permit and construction
inspection for the project is under the local building jurisdiction.
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CODE APPLICATION NOTICE (CAN)
23. The CDPH will survey surgical and dialysis clinics for compliance to NFPA 101.
24. Rehabilitation Clinics and Alternate Birthing Centers are not subject to OSHPD review or
certification.
25. Rehabilitation Clinics and Alternate Birthing Centers are under the jurisdiction of the local
building jurisdiction only. Conformance to OSHPD 3 is required.
26. Primary Care Clinics and Psychology clinics, as defined in H&SC Section 1200, are required
to conform to the requirements of OSHPD 3. Certification to OSHPD 3 may be required for
Primary Care Clinics which may include community Clinics, free Clinics, employee clinics and
optometric clinics.
27. Primary Care Clinics are under the jurisdiction of the local building jurisdiction only.
Conformance to OSHPD 3 is required. Written certification to OSHPD 3 may be provided
by a licensed architect or the local building jurisdiction. (H&SC Section 1226.3)
28. Doctor offices not licensed as clinics are not subject to OSHPD 3 regulations or certification.
29. These buildings are reviewed by the local building jurisdiction, and are not subject to
OSHPD 3 regulations or OSHPD plan review.
30. If an Ambulatory Surgical Center (ASC) licensed for Medicare reimbursement only is not
licensed as a specialty clinic, conformance and certification to OSHPD 3 are not required.
31. These facilities are reviewed by the local building jurisdiction, and are not subject to OSHPD 3
regulations or OSHPD plan review.
32. The CDPH will survey ASC for compliance to NFPA 101.
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CODE APPLICATION NOTICE (CAN)
APPENDIX
GLOSSARY
Certification for Medicare and/or Medicaid – (Not related to OSHPD 3 certification
requirements) A process to determine the eligibility of health care providers for
reimbursement under the Medicare and/or Medicaid (Medi-Cal) programs. Certification for
Medicare is provided by CMS, based on recommendation by CDPH. Certification for MediCal is provided by CDPH.
Certification of Nonhospital Freestanding Building Outpatient Clinical Services
(H&SC Sections 1250 and 129730) - A written document from the local building jurisdiction
or OSHPD stating that design drawings, specifications and/or construction for licensed
clinics are in compliance with applicable OSHPD 3 requirements. This certification is only
for OSHPD 3 requirements, and is in addition to the normal plan review process provided by
the local building official. Certification to OSHPD 3 requirements is a completely separate
process from certification for Medicare and/or Medicaid.
Certification of Licensed Freestanding Specialty Clinics (H&SC Section 1200) - A
written document from the local building jurisdiction or OSHPD stating that design drawings,
specifications and/or construction for surgical or dialysis licensed clinics are in compliance
with applicable OSHPD 3 requirements. This certification is only for OSHPD 3
requirements, and is in addition to the normal plan review process provided by the local
building jurisdiction. Certification to OSHPD 3 requirements is a completely separate
process from certification for Medicare and/or Medicaid.
Certification to Primary Care Clinic (H&SC Section 1226.3) – A primary clinic may
establish compliance with the minimum construction standards of adequacy and safety for
the physical plant by submitting written certification from a licensed architect or a written
statement from a local building jurisdiction that design drawings, specifications and/or
construction for a specified licensed clinic are in compliance with applicable OSHPD 3
requirements.
Clinic – An outpatient health facility which provides direct medical, surgical, dental,
optometric, or podiatric advice, services, or treatment to patients who remain less than 24
hours. (H&SC Section 1200.1) (Also see definition of “Outpatient Clinical Services of a
Licensed Hospital”.)
Dental Clinic – Provides comprehensive dental services, and is licensed as a Primary Care
Clinic by CDPH. A dental office provides comprehensive dental services to patients, but is
not a licensed clinic.
Employee Clinic – Operated by an employer or jointly by two or more employers for their
employees only, or by a group of employees, or jointly by employees and employers,
without profit to the operators thereof or to any other person, for the prevention and
treatment of accidental injuries to, and the care of the health of, the employees comprising
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CODE APPLICATION NOTICE (CAN)
the group. Employee clinics are specifically exempted from licensure requirements of
H&SC, Division 2, Chapter 1, Clinics. (H&SC Section 1206(n))
Optometric Clinic – Provides comprehensive eye services to patients. It may be licensed
as a Primary Care Clinic or Surgical Clinic. An Optometric Office provides optometric
services, but is not a licensed clinic.
Primary Care Clinic – Clinics specified in H&SC Section 1204 (a) :
Community Clinic – A clinic operated by a tax-exempt nonprofit corporation that is
supported and maintained in whole or in part by donations, bequests, gifts, grants,
government funds or contributions, that may be in the form of money, goods, or services.
In a community clinic, any charges to the patient shall be based on the patient's ability to
pay, utilizing a sliding fee scale. No corporation other than a nonprofit corporation,
exempt from federal income taxation under paragraph (3) of subsection (c) of Section
501 of the Internal Revenue Code of 1954 as amended, or a statutory successor thereof,
shall operate a community clinic; provided, that the licensee of any community clinic so
licensed on the effective date of this section shall not be required to obtain tax-exempt
status under either federal or state law in order to be eligible for, or as a condition of,
renewal of its license. No natural person or persons shall operate a community clinic.
(H&SC Section 1204(a)(1))
Free Clinic – A clinic operated by a tax-exempt, nonprofit corporation supported in
whole or in part by voluntary donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services. In a free clinic there
shall be no charges directly to the patient for services rendered or for drugs, medicines,
appliances, or apparatuses furnished. No corporation other than a nonprofit corporation
exempt from federal income taxation under paragraph (3) of subsection (c) of Section
501 of the Internal Revenue Code of 1954 as amended, or a statutory successor thereof,
shall operate a free clinic; provided, that the licensee of any free clinic so licensed on the
effective date of this section shall not be required to obtain tax-exempt status under
either federal or state law in order to be eligible for, or as a condition of, renewal of its
license. No natural person or persons shall operate a free clinic. (H&SC Section
1204(a)(2))
Psychology Clinic – A clinic which provides psychological advice, services, or treatment to
patients, under the direction of a clinical psychologist as defined in Section 1316.5, and is
operated by a tax-exempt nonprofit corporation which is supported and maintained in whole
or in part by donations, bequests, gifts, grants, government funds, or contributions which
may be in the form of money, goods, or services. In a psychology clinic, any charges to the
patient shall be based on the patient's ability to pay, utilizing a sliding fee scale. No
corporation other than a nonprofit corporation, exempt from federal taxation under
paragraph (3), subsection (c) of Section (501 of the Internal Revenue Code of 1954, as
amended, or a statutory successor thereof, shall operate a psychology clinic. (H&SC
Section 1204.1) Psychology clinics are eligible for licensure pursuant to H&SC, Division 2,
Chapter 1, Clinics, but are not required to be licensed. (H&SC Section 1206.1)
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Specialty Clinic – Types of clinics specified in H&SC subdivision (b) of Section 1204,
including surgical clinics, chronic dialysis clinics, rehabilitation clinics and alternate birth
centers. Specialty clinics must be licensed by CDPH, except for surgical clinics that are
under a physician’s medical license or corporation.
Surgical Clinic – Provides ambulatory surgical care for patients who remain less than
24 hours. A surgical clinic does not include any place or establishment owned or leased
and operated as a clinic or office by one or more physicians or dentists in individual or
group practice, regardless of the name used publicly to identify the place or
establishment, provided, however, that physicians or dentists may, at their option, apply
for licensure. (H&SC Section 1204(b)(1))
Chronic Dialysis Clinic (ESRD, End-Stage Renal Dialysis) – A clinic that provides
less than 24-hour care for the treatment of patients with end-stage renal disease,
including renal dialysis services. (H&SC Section 1204(b)(2))
Rehabilitation Clinic – A clinic that, in addition to providing medical services directly,
also provides physical rehabilitation services for patients who remain less than 24 hours.
Rehabilitation clinics shall provide at least two of the following rehabilitation services:
physical therapy, occupational therapy, social, speech pathology, and audiology
services. A rehabilitation clinic does not include the offices of a private physician in
individual or group practice. (H&SC Section 1204(b)(3))
Alternative Birth Center (ABC) – A clinic that provides comprehensive perinatal
services and delivery care to pregnant women who remain less than 24 hours at the
facility. (H&SC Section 1204(b)(4))
Health &Safety Code Section 1200 – Statute that pertains to licensed clinics not under a
hospital license.
Health &Safety Code Section 1250– Statute that pertains to “health facilities,” which
include general acute care hospitals, and outpatient clinics under a hospital license.
Hospital Building – Hospital building is any building used for a health facility of a type
required to be licensed pursuant to Section 1250 of the Health and Safety Code. The facility
may also need to comply with NFPA 101 requirements for CMS and JCAHO standards
under the Environment of Care. “Hospital building” does not include any building in which
outpatient clinical services of a health facility licensed pursuant to Section 1250 are provided
that is separated from a building in which hospital services are provided. If any one or more
outpatient clinical services in the building provide services to inpatients, the building shall
not be included as a "hospital building" if those services provided to inpatients represent no
more than 25 percent of the total outpatient visits provided at the building. Hospitals shall
maintain on an ongoing basis, data on the patients receiving services in these buildings,
including the number of patients seen, categorized by their inpatient or outpatient status.
Hospitals shall submit this data annually to the CDPH.
License – A written authorization to operate a health facility and/or clinic issued by the
CDPH.
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Local – See Local Building Jurisdiction.
Local Building Jurisdiction – City, county, or city and county building department, and fire
authority responsible for enforcing the Title 24, California Building Standards Code.
National Fire Protection Association (NFPA) Standard 101 – Life Safety Code, published
by NFPA. Surveys for compliance to 2000 edition of NFPA 101 are performed by CDPH.
Outpatient Clinical Services of a Licensed Hospital – A service under a hospital license
that provides non-emergency health care services to patients. The clinic needs to be
freestanding and comply with Title 24 requirements including OSHPD 3. NFPA 101
requirements for CMS and JCAHO standards under the Environment of Care may also be
applicable. The number of inpatients may represent no more than 25% of the total number
of patients served by the clinic. Services provided may include those enumerated in H&SC
Section 129730.
OSHPD 3 – Regulations promulgated by OSHPD that apply to licensed clinics and hospital
outpatient clinical services provided in a freestanding nonhospital building. OSHPD 3
regulations and other applicable requirements are found in the following parts of Title 24:
•
•
•
•
•
Part 1, California Administrative Code (CAC), Article 21
Part 2, California Building Code (CBC), including Section 1226
Part 3, California Electrical Code (CEC)
Part 4, California Mechanical Code (CMC), including Tables 4-A and 4-B
Part 5, California Plumbing Code (CPC)
Title 24 – California Code of Regulations (CCR), Title 24, also known as the California
Building Standards Code. Title 24 includes the following parts:
•
•
•
•
•
•
•
•
•
•
•
•
Part 1, California Administrative Code
Part 2, California Building Code
Part 3, California Electrical Code
Part 4, California Mechanical Code
Part 5, California Plumbing Code
Part 6, California Energy Code
Part 7, California Elevator Safety Construction Code (See CCR, Title 8)
Part 8, California Historical Building Code
Part 9, California Fire Code
Part 10, California Code for Building Conservation
Part 11, California Green Building Standards Code
Part 12, California Reference Standards Code
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ROLES OF THE AGENCIES INVOLVED
California Medical Board – Responsible for licensing physicians to provide medical care.
California Department of Public Health (CDPH) – Verifies that operational requirements are
met and issues a license to operate a licensed clinic. CDPH also conducts the life safety
portion of the survey, enforcing the 2000 edition of NFPA 101, Life Safety Code. Clinics must
meet both State and Federal standards as a condition of participation in the Medicare program.
Local Building Jurisdiction (LBJ) – Responsible for plan review, building permit issuance,
building construction inspection, and issuance of certificate of occupancy. A written certification
of conformance with OSHPD 3 amendments is required for Surgical and Dialysis Clinics. When
the local building jurisdiction provides certification, it shall certify within 30 days of the
completion of construction that the applicable clinic provisions have been met. The local
building jurisdiction may choose not to provide this certification, requiring submittal to OSHPD
for plan review and certification.
Local fire department – Enforces all fire and life safety requirements Office of the State Fire
Marshal (SFM) in Title 24.
Office of Statewide Health Planning and Development (OSHPD) – In consultation with the
Community Clinics Advisory Committee, OSHPD shall prescribe minimum construction
standards of adequacy and safety for the physical plant of clinics as found in the California
Building Standards Code. Additionally, OSHPD may perform a role in the plan review, building
inspection and certification process as described in Title 24, Part 1, Article 21, “Plan Review,
Building Inspection and Certification of Surgical Clinics, Chronic Dialysis Clinics and Outpatient
Services Clinics.”
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ACRONYMS
ABC
Alternative Birthing Center
ASC
Ambulatory Surgical Center
CCR
California Code of Regulations
CDPH
California Department of Public Health
CMS
Center for Medicare/Medicaid Services (formerly known as Healthcare Financing
Association (HCFA))
ESRD
End Stage Renal Dialysis
H&SC
Health and Safety Code
JCAHO
Joint Commission Accreditation Hospitals and Organizations known as the Joint
Commission
NFPA
National Fire Protection Association
OSHPD
Office of Statewide Health Planning and Development
SFM
Office of the State Fire Marshal
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California Medical Clinic Guidelines
Plan Review, Approval, Inspection and Certification
Flowchart Explanatory Notes (Keyed to numbers at upper left corner of each box on flowchart.)
Citations are from the Health and Safety Code (H&SC) and the California Administrative Code
(CAC) Chapter 7.
1.
If the clinic is not licensed by California Department of Public Health (CDPH), Licensing and
Certification, compliance and certification to the requirements of OSHPD 3 are not required.
2.
How a clinic is licensed will affect which sections Title 24, California Building Standards Code
apply, how they are applied and what agency (local building jurisdiction or OSHPD) will
enforce them.
3.
“Hospital building” is defined in H&SC Section 1250. OSHPD preempts the local building
jurisdiction for enforcement of the Title 24, California Building Standards Code.
4.
Hospital buildings are subject to OSHPD jurisdiction and must comply with OSHPD 1
requirements in the CBC.
5.
Freestanding clinic buildings under the hospital license are typically subject to the local
building jurisdiction, although they are licensed under H&SC Section 1250.
6.
The owner or governing authority may submit plans directly to the local building jurisdiction or
may select OSHPD to perform the plan review and certification for freestanding hospital
outpatient clinics. (Also refer to OSHPD Code Application Notice (CAN) 1-6-1.4.5.1.4,
“Removal of Acute Care Services”.)
7.
If the governing authority selects OSHPD to perform the plan review and certification
responsibilities for a freestanding hospital licensed outpatient clinic, then the entire project,
including plan review and approval to Title 24 including OSHPD 3 requirements, building
permit and construction inspection is under OSHPD jurisdiction.
8.
Freestanding clinic buildings that have been reviewed by OSHPD will remain under the
jurisdiction of the Office until the owner or governing authority notifies OSHPD otherwise in
writing.
9.
Written certification of compliance to OSHPD 3 is required for outpatient clinical services of a
hospital including surgical clinics and dialysis clinics. If plans are submitted to the local
building jurisdiction, the local building jurisdiction must notify the owner or governing authority
if their review will include written certification for OSHPD 3 conformance.
10. If the local building jurisdiction will not provide written certification to OSHPD 3 requirements,
then plans shall be submitted to OSHPD for plan review and certification to OSHPD 3
requirements only. The local building jurisdiction shall review the plans for compliance to
Title 24 excluding OSHPD 3.
11. Concurrent with OSHPD’s review to OSHPD 3 requirements, the local building jurisdiction
reviews the plans for compliance to Title 24, except OSHPD 3. The design professional of
record is required to coordinate the OSHPD certification documents with those permitted by
14
the local jurisdiction. The local building jurisdiction shall also issue the building permit and
perform construction inspection to Title 24 including OSHPD 3 requirements.
12. If the local building jurisdiction will provide written certification to OSHPD 3 requirements, then
the entire project, including plan review and approval, building permit and construction
inspection for the project is under the local building jurisdiction.
13. Licensed freestanding specialty clinics are defined in H&SC Section 1200. Specialty clinics
include surgical, chronic dialysis, and rehabilitation clinics and alternate birthing centers. All
specialty clinics are required to conform to the requirements of OSHPD 3.
14. Written certification to OSHPD 3 is required for licensed surgical and dialysis specialty clinics
and only these specialty clinics may be reviewed and certified by OSHPD.
15. The owner or governing authority must submit plans directly to the local building jurisdiction or
may request OSHPD to perform the plan review and certification for surgery and dialysis
specialty clinics.
16. OSHPD must consult with the local building jurisdiction, and either accept or not accept the
clinic project for plan review. One purpose for this consultation is to determine whether or not
the local building jurisdiction will issue a building permit and inspect construction for a project
for which OSHPD did the plan review. If the local building jurisdiction is unwilling or unable to
do this, OSHPD cannot accept the review.
17.
If, after consultation with the local building jurisdiction, OSHPD accepts the project for plan
review, then OSHPD must perform a complete plan review of Title 24 requirements, including
OSHPD 3. The local building jurisdiction is not involved in plan review.
18. The local building jurisdiction must issue the building permit and perform construction
inspection to Title 24 including OSHPD 3.
19. If plans are submitted to the local building jurisdiction, the local building jurisdiction must notify
the owner or governing authority if their review will include certification for OSHPD 3
conformance.
20. If the local building jurisdiction will not provide written certification to OSHPD 3 requirements,
then plans shall be submitted to OSHPD for plan review and certification to OSHPD 3
requirements only. The local building jurisdiction shall review the plans for compliance to
Title 24 excluding OSHPD 3.
21. Concurrent with OSHPD’s review to OSHPD 3 requirements, the local building jurisdiction
reviews the plans for compliance to Title 24, except OSHPD 3. The design professional of
record is required to coordinate the OSHPD certification documents with those permitted by
the local jurisdiction. The local building jurisdiction shall also issue the building permit and
perform construction inspection to Title 24 including OSHPD 3.
22. If the local building jurisdiction will provide written certification to OSHPD 3 requirements, then
the entire project, including plan review and approval, building permit and construction
inspection for the project is under the local building jurisdiction.
15
23. The CDPH will survey surgical and dialysis clinics for compliance to NFPA 101.
24. Rehabilitation Clinics and Alternate Birthing Centers are not subject to OSHPD review or
certification.
25. Rehabilitation Clinics and Alternate Birthing Centers are under the jurisdiction of the local
building jurisdiction only. Conformance to OSHPD 3 is required.
26. Primary Care Clinics and Psychology clinics, as defined in H&SC Section 1200, are required
to conform to the requirements of OSHPD 3. Certification to OSHPD 3 may be required for
Primary Care Clinics which may include community Clinics, free Clinics, employee clinics and
optometric clinics.
27. Primary Care Clinics are under the jurisdiction of the local building jurisdiction only.
Conformance to OSHPD 3 is required. Written certification to OSHPD 3 may be provided
by a licensed architect or the local building jurisdiction. (H&SC Section 1226.3)
28. Doctor offices not licensed as clinics are not subject to OSHPD 3 regulations or certification.
29. These buildings are reviewed by the local building jurisdiction, and are not subject to
OSHPD 3 regulations or OSHPD plan review.
30. If an Ambulatory Surgical Center (ASC) licensed for Medicare reimbursement only is not
licensed as a specialty clinic, conformance and certification to OSHPD 3 are not required.
31. These facilities are reviewed by the local building jurisdiction, and are not subject to OSHPD 3
regulations or OSHPD plan review.
32. The CDPH will survey ASC for compliance to NFPA 101.
16
APPENDIX
GLOSSARY
Certification for Medicare and/or Medicaid – (Not related to OSHPD 3 certification
requirements) A process to determine the eligibility of health care providers for
reimbursement under the Medicare and/or Medicaid (Medi-Cal) programs. Certification for
Medicare is provided by CMS, based on recommendation by CDPH. Certification for MediCal is provided by CDPH.
Certification of Nonhospital Freestanding Building Outpatient Clinical Services
(H&SC Sections 1250 and 129730) - A written document from the local building jurisdiction
or OSHPD stating that design drawings, specifications and/or construction for licensed
clinics are in compliance with applicable OSHPD 3 requirements. This certification is only
for OSHPD 3 requirements, and is in addition to the normal plan review process provided by
the local building official. Certification to OSHPD 3 requirements is a completely separate
process from certification for Medicare and/or Medicaid.
Certification of Licensed Freestanding Specialty Clinics (H&SC Section 1200) - A
written document from the local building jurisdiction or OSHPD stating that design drawings,
specifications and/or construction for surgical or dialysis licensed clinics are in compliance
with applicable OSHPD 3 requirements. This certification is only for OSHPD 3
requirements, and is in addition to the normal plan review process provided by the local
building jurisdiction. Certification to OSHPD 3 requirements is a completely separate
process from certification for Medicare and/or Medicaid.
Certification to Primary Care Clinic (H&SC Section 1226.3) – A primary clinic may
establish compliance with the minimum construction standards of adequacy and safety for
the physical plant by submitting written certification from a licensed architect or a written
statement from a local building jurisdiction that design drawings, specifications and/or
construction for a specified licensed clinic are in compliance with applicable OSHPD 3
requirements.
Clinic – An outpatient health facility which provides direct medical, surgical, dental,
optometric, or podiatric advice, services, or treatment to patients who remain less than 24
hours. (H&SC Section 1200.1) (Also see definition of “Outpatient Clinical Services of a
Licensed Hospital”.)
Dental Clinic – Provides comprehensive dental services, and is licensed as a Primary Care
Clinic by CDPH. A dental office provides comprehensive dental services to patients, but is
not a licensed clinic.
Employee Clinic – Operated by an employer or jointly by two or more employers for their
employees only, or by a group of employees, or jointly by employees and employers,
without profit to the operators thereof or to any other person, for the prevention and
treatment of accidental injuries to, and the care of the health of, the employees comprising
17
the group. Employee clinics are specifically exempted from licensure requirements of
H&SC, Division 2, Chapter 1, Clinics. (H&SC Section 1206(n))
Optometric Clinic – Provides comprehensive eye services to patients. It may be licensed
as a Primary Care Clinic or Surgical Clinic. An Optometric Office provides optometric
services, but is not a licensed clinic.
Primary Care Clinic – Clinics specified in H&SC Section 1204 (a) :
Community Clinic – A clinic operated by a tax-exempt nonprofit corporation that is
supported and maintained in whole or in part by donations, bequests, gifts, grants,
government funds or contributions, that may be in the form of money, goods, or services.
In a community clinic, any charges to the patient shall be based on the patient's ability to
pay, utilizing a sliding fee scale. No corporation other than a nonprofit corporation,
exempt from federal income taxation under paragraph (3) of subsection (c) of Section
501 of the Internal Revenue Code of 1954 as amended, or a statutory successor thereof,
shall operate a community clinic; provided, that the licensee of any community clinic so
licensed on the effective date of this section shall not be required to obtain tax-exempt
status under either federal or state law in order to be eligible for, or as a condition of,
renewal of its license. No natural person or persons shall operate a community clinic.
(H&SC Section 1204(a)(1))
Free Clinic – A clinic operated by a tax-exempt, nonprofit corporation supported in
whole or in part by voluntary donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services. In a free clinic there
shall be no charges directly to the patient for services rendered or for drugs, medicines,
appliances, or apparatuses furnished. No corporation other than a nonprofit corporation
exempt from federal income taxation under paragraph (3) of subsection (c) of Section
501 of the Internal Revenue Code of 1954 as amended, or a statutory successor thereof,
shall operate a free clinic; provided, that the licensee of any free clinic so licensed on the
effective date of this section shall not be required to obtain tax-exempt status under
either federal or state law in order to be eligible for, or as a condition of, renewal of its
license. No natural person or persons shall operate a free clinic. (H&SC Section
1204(a)(2))
Psychology Clinic – A clinic which provides psychological advice, services, or treatment to
patients, under the direction of a clinical psychologist as defined in Section 1316.5, and is
operated by a tax-exempt nonprofit corporation which is supported and maintained in whole
or in part by donations, bequests, gifts, grants, government funds, or contributions which
may be in the form of money, goods, or services. In a psychology clinic, any charges to the
patient shall be based on the patient's ability to pay, utilizing a sliding fee scale. No
corporation other than a nonprofit corporation, exempt from federal taxation under
paragraph (3), subsection (c) of Section (501 of the Internal Revenue Code of 1954, as
amended, or a statutory successor thereof, shall operate a psychology clinic. (H&SC
Section 1204.1) Psychology clinics are eligible for licensure pursuant to H&SC, Division 2,
Chapter 1, Clinics, but are not required to be licensed. (H&SC Section 1206.1)
18
Specialty Clinic – Types of clinics specified in H&SC subdivision (b) of Section 1204,
including surgical clinics, chronic dialysis clinics, rehabilitation clinics and alternate birth
centers. Specialty clinics must be licensed by CDPH, except for surgical clinics that are
under a physician’s medical license or corporation.
Surgical Clinic – Provides ambulatory surgical care for patients who remain less than
24 hours. A surgical clinic does not include any place or establishment owned or leased
and operated as a clinic or office by one or more physicians or dentists in individual or
group practice, regardless of the name used publicly to identify the place or
establishment, provided, however, that physicians or dentists may, at their option, apply
for licensure. (H&SC Section 1204(b)(1))
Chronic Dialysis Clinic (ESRD, End-Stage Renal Dialysis) – A clinic that provides
less than 24-hour care for the treatment of patients with end-stage renal disease,
including renal dialysis services. (H&SC Section 1204(b)(2))
Rehabilitation Clinic – A clinic that, in addition to providing medical services directly,
also provides physical rehabilitation services for patients who remain less than 24 hours.
Rehabilitation clinics shall provide at least two of the following rehabilitation services:
physical therapy, occupational therapy, social, speech pathology, and audiology
services. A rehabilitation clinic does not include the offices of a private physician in
individual or group practice. (H&SC Section 1204(b)(3))
Alternative Birth Center (ABC) – A clinic that provides comprehensive perinatal
services and delivery care to pregnant women who remain less than 24 hours at the
facility. (H&SC Section 1204(b)(4))
Health &Safety Code Section 1200 – Statute that pertains to licensed clinics not under a
hospital license.
Health &Safety Code Section 1250– Statute that pertains to “health facilities,” which
include general acute care hospitals, and outpatient clinics under a hospital license.
Hospital Building – Hospital building is any building used for a health facility of a type
required to be licensed pursuant to Section 1250 of the Health and Safety Code. The facility
may also need to comply with NFPA 101 requirements for CMS and JCAHO standards
under the Environment of Care. “Hospital building” does not include any building in which
outpatient clinical services of a health facility licensed pursuant to Section 1250 are provided
that is separated from a building in which hospital services are provided. If any one or more
outpatient clinical services in the building provide services to inpatients, the building shall
not be included as a "hospital building" if those services provided to inpatients represent no
more than 25 percent of the total outpatient visits provided at the building. Hospitals shall
maintain on an ongoing basis, data on the patients receiving services in these buildings,
including the number of patients seen, categorized by their inpatient or outpatient status.
Hospitals shall submit this data annually to the CDPH.
License – A written authorization to operate a health facility and/or clinic issued by the
CDPH.
19
Local – See Local Building Jurisdiction.
Local Building Jurisdiction – City, county, or city and county building department, and fire
authority responsible for enforcing the Title 24, California Building Standards Code.
National Fire Protection Association (NFPA) Standard 101 – Life Safety Code, published
by NFPA. Surveys for compliance to 2000 edition of NFPA 101 are performed by CDPH.
Outpatient Clinical Services of a Licensed Hospital – A service under a hospital license
that provides non-emergency health care services to patients. The clinic needs to be
freestanding and comply with Title 24 requirements including OSHPD 3. NFPA 101
requirements for CMS and JCAHO standards under the Environment of Care may also be
applicable. The number of inpatients may represent no more than 25% of the total number
of patients served by the clinic. Services provided may include those enumerated in H&SC
Section 129730.
OSHPD 3 – Regulations promulgated by OSHPD that apply to licensed clinics and hospital
outpatient clinical services provided in a freestanding nonhospital building. OSHPD 3
regulations and other applicable requirements are found in the following parts of Title 24:
•
•
•
•
•
Part 1, California Administrative Code (CAC), Article 21
Part 2, California Building Code (CBC), including Section 1226
Part 3, California Electrical Code (CEC)
Part 4, California Mechanical Code (CMC), including Tables 4-A and 4-B
Part 5, California Plumbing Code (CPC)
Title 24 – California Code of Regulations (CCR), Title 24, also known as the California
Building Standards Code. Title 24 includes the following parts:
•
•
•
•
•
•
•
•
•
•
•
•
Part 1, California Administrative Code
Part 2, California Building Code
Part 3, California Electrical Code
Part 4, California Mechanical Code
Part 5, California Plumbing Code
Part 6, California Energy Code
Part 7, California Elevator Safety Construction Code (See CCR, Title 8)
Part 8, California Historical Building Code
Part 9, California Fire Code
Part 10, California Code for Building Conservation
Part 11, California Green Building Standards Code
Part 12, California Reference Standards Code
20
ROLES OF THE AGENCIES INVOLVED
California Medical Board – Responsible for licensing physicians to provide medical care.
California Department of Public Health (CDPH) – Verifies that operational requirements are
met and issues a license to operate a licensed clinic. CDPH also conducts the life safety
portion of the survey, enforcing the 2000 edition of NFPA 101, Life Safety Code. Clinics must
meet both State and Federal standards as a condition of participation in the Medicare program.
Local Building Jurisdiction (LBJ) – Responsible for plan review, building permit issuance,
building construction inspection, and issuance of certificate of occupancy. A written certification
of conformance with OSHPD 3 amendments is required for Surgical and Dialysis Clinics. When
the local building jurisdiction provides certification, it shall certify within 30 days of the
completion of construction that the applicable clinic provisions have been met. The local
building jurisdiction may choose not to provide this certification, requiring submittal to OSHPD
for plan review and certification.
Local fire department – Enforces all fire and life safety requirements Office of the State Fire
Marshal (SFM) in Title 24.
Office of Statewide Health Planning and Development (OSHPD) – In consultation with the
Community Clinics Advisory Committee, OSHPD shall prescribe minimum construction
standards of adequacy and safety for the physical plant of clinics as found in the California
Building Standards Code. Additionally, OSHPD may perform a role in the plan review, building
inspection and certification process as described in Title 24, Part 1, Article 21, “Plan Review,
Building Inspection and Certification of Surgical Clinics, Chronic Dialysis Clinics and Outpatient
Services Clinics.”
21
ACRONYMS
ABC
Alternative Birthing Center
ASC
Ambulatory Surgical Center
CCR
California Code of Regulations
CDPH
California Department of Public Health
CMS
Center for Medicare/Medicaid Services (formerly known as Healthcare Financing
Association (HCFA))
ESRD
End Stage Renal Dialysis
H&SC
Health and Safety Code
JCAHO
Joint Commission Accreditation Hospitals and Organizations known as the Joint
Commission
NFPA
National Fire Protection Association
OSHPD
Office of Statewide Health Planning and Development
SFM
Office of the State Fire Marshal
22
California Medical Clinic Guidelines
Plan Review, Approval, Inspection and Certification
Flowchart Explanatory Notes (Keyed to numbers at upper left corner of each box on flowchart.)
Citations are from the Health and Safety Code (H&SC) and the California Administrative Code
(CAC) Chapter 7.
1.
If the clinic is not licensed by California Department of Public Health (CDPH), Licensing and
Certification, compliance and certification to the requirements of OSHPD 3 are not required.
2.
How a clinic is licensed will affect which sections Title 24, California Building Standards Code
apply, how they are applied and what agency (local building jurisdiction or OSHPD) will
enforce them.
3.
“Hospital building” is defined in H&SC Section 1250. OSHPD preempts the local building
jurisdiction for enforcement of the Title 24, California Building Standards Code.
4.
Hospital buildings are subject to OSHPD jurisdiction and must comply with OSHPD 1
requirements in the CBC.
5.
Freestanding clinic buildings under the hospital license are typically subject to the local
building jurisdiction, although they are licensed under H&SC Section 1250.
6.
The owner or governing authority may submit plans directly to the local building jurisdiction or
may select OSHPD to perform the plan review and certification for freestanding hospital
outpatient clinics. (Also refer to OSHPD Code Application Notice (CAN) 1-6-1.4.5.1.4,
“Removal of Acute Care Services”.)
7.
If the governing authority selects OSHPD to perform the plan review and certification
responsibilities for a freestanding hospital licensed outpatient clinic, then the entire project,
including plan review and approval to Title 24 including OSHPD 3 requirements, building
permit and construction inspection is under OSHPD jurisdiction.
8.
Freestanding clinic buildings that have been reviewed by OSHPD will remain under the
jurisdiction of the Office until the owner or governing authority notifies OSHPD otherwise in
writing.
9.
Written certification of compliance to OSHPD 3 is required for outpatient clinical services of a
hospital including surgical clinics and dialysis clinics. If plans are submitted to the local
building jurisdiction, the local building jurisdiction must notify the owner or governing authority
if their review will include written certification for OSHPD 3 conformance.
10. If the local building jurisdiction will not provide written certification to OSHPD 3 requirements,
then plans shall be submitted to OSHPD for plan review and certification to OSHPD 3
requirements only. The local building jurisdiction shall review the plans for compliance to
Title 24 excluding OSHPD 3.
11. Concurrent with OSHPD’s review to OSHPD 3 requirements, the local building jurisdiction
reviews the plans for compliance to Title 24, except OSHPD 3. The design professional of
record is required to coordinate the OSHPD certification documents with those permitted by
23
the local jurisdiction. The local building jurisdiction shall also issue the building permit and
perform construction inspection to Title 24 including OSHPD 3 requirements.
12. If the local building jurisdiction will provide written certification to OSHPD 3 requirements, then
the entire project, including plan review and approval, building permit and construction
inspection for the project is under the local building jurisdiction.
13. Licensed freestanding specialty clinics are defined in H&SC Section 1200. Specialty clinics
include surgical, chronic dialysis, and rehabilitation clinics and alternate birthing centers. All
specialty clinics are required to conform to the requirements of OSHPD 3.
14. Written certification to OSHPD 3 is required for licensed surgical and dialysis specialty clinics
and only these specialty clinics may be reviewed and certified by OSHPD.
15. The owner or governing authority must submit plans directly to the local building jurisdiction or
may request OSHPD to perform the plan review and certification for surgery and dialysis
specialty clinics.
16. OSHPD must consult with the local building jurisdiction, and either accept or not accept the
clinic project for plan review. One purpose for this consultation is to determine whether or not
the local building jurisdiction will issue a building permit and inspect construction for a project
for which OSHPD did the plan review. If the local building jurisdiction is unwilling or unable to
do this, OSHPD cannot accept the review.
17.
If, after consultation with the local building jurisdiction, OSHPD accepts the project for plan
review, then OSHPD must perform a complete plan review of Title 24 requirements, including
OSHPD 3. The local building jurisdiction is not involved in plan review.
18. The local building jurisdiction must issue the building permit and perform construction
inspection to Title 24 including OSHPD 3.
19. If plans are submitted to the local building jurisdiction, the local building jurisdiction must notify
the owner or governing authority if their review will include certification for OSHPD 3
conformance.
20. If the local building jurisdiction will not provide written certification to OSHPD 3 requirements,
then plans shall be submitted to OSHPD for plan review and certification to OSHPD 3
requirements only. The local building jurisdiction shall review the plans for compliance to
Title 24 excluding OSHPD 3.
21. Concurrent with OSHPD’s review to OSHPD 3 requirements, the local building jurisdiction
reviews the plans for compliance to Title 24, except OSHPD 3. The design professional of
record is required to coordinate the OSHPD certification documents with those permitted by
the local jurisdiction. The local building jurisdiction shall also issue the building permit and
perform construction inspection to Title 24 including OSHPD 3.
22. If the local building jurisdiction will provide written certification to OSHPD 3 requirements, then
the entire project, including plan review and approval, building permit and construction
inspection for the project is under the local building jurisdiction.
24
23. The CDPH will survey surgical and dialysis clinics for compliance to NFPA 101.
24. Rehabilitation Clinics and Alternate Birthing Centers are not subject to OSHPD review or
certification.
25. Rehabilitation Clinics and Alternate Birthing Centers are under the jurisdiction of the local
building jurisdiction only. Conformance to OSHPD 3 is required.
26. Primary Care Clinics and Psychology clinics, as defined in H&SC Section 1200, are required
to conform to the requirements of OSHPD 3. Certification to OSHPD 3 may be required for
Primary Care Clinics which may include community Clinics, free Clinics, employee clinics and
optometric clinics.
27. Primary Care Clinics are under the jurisdiction of the local building jurisdiction only.
Conformance to OSHPD 3 is required. Written certification to OSHPD 3 may be provided
by a licensed architect or the local building jurisdiction. (H&SC Section 1226.3)
28. Doctor offices not licensed as clinics are not subject to OSHPD 3 regulations or certification.
29. These buildings are reviewed by the local building jurisdiction, and are not subject to
OSHPD 3 regulations or OSHPD plan review.
30. If an Ambulatory Surgical Center (ASC) licensed for Medicare reimbursement only is not
licensed as a specialty clinic, conformance and certification to OSHPD 3 are not required.
31. These facilities are reviewed by the local building jurisdiction, and are not subject to OSHPD 3
regulations or OSHPD plan review.
32. The CDPH will survey ASC for compliance to NFPA 101.
25
APPENDIX
GLOSSARY
Certification for Medicare and/or Medicaid – (Not related to OSHPD 3 certification
requirements) A process to determine the eligibility of health care providers for
reimbursement under the Medicare and/or Medicaid (Medi-Cal) programs. Certification for
Medicare is provided by CMS, based on recommendation by CDPH. Certification for MediCal is provided by CDPH.
Certification of Nonhospital Freestanding Building Outpatient Clinical Services
(H&SC Sections 1250 and 129730) - A written document from the local building jurisdiction
or OSHPD stating that design drawings, specifications and/or construction for licensed
clinics are in compliance with applicable OSHPD 3 requirements. This certification is only
for OSHPD 3 requirements, and is in addition to the normal plan review process provided by
the local building official. Certification to OSHPD 3 requirements is a completely separate
process from certification for Medicare and/or Medicaid.
Certification of Licensed Freestanding Specialty Clinics (H&SC Section 1200) - A
written document from the local building jurisdiction or OSHPD stating that design drawings,
specifications and/or construction for surgical or dialysis licensed clinics are in compliance
with applicable OSHPD 3 requirements. This certification is only for OSHPD 3
requirements, and is in addition to the normal plan review process provided by the local
building jurisdiction. Certification to OSHPD 3 requirements is a completely separate
process from certification for Medicare and/or Medicaid.
Certification to Primary Care Clinic (H&SC Section 1226.3) – A primary clinic may
establish compliance with the minimum construction standards of adequacy and safety for
the physical plant by submitting written certification from a licensed architect or a written
statement from a local building jurisdiction that design drawings, specifications and/or
construction for a specified licensed clinic are in compliance with applicable OSHPD 3
requirements.
Clinic – An outpatient health facility which provides direct medical, surgical, dental,
optometric, or podiatric advice, services, or treatment to patients who remain less than 24
hours. (H&SC Section 1200.1) (Also see definition of “Outpatient Clinical Services of a
Licensed Hospital”.)
Dental Clinic – Provides comprehensive dental services, and is licensed as a Primary Care
Clinic by CDPH. A dental office provides comprehensive dental services to patients, but is
not a licensed clinic.
Employee Clinic – Operated by an employer or jointly by two or more employers for their
employees only, or by a group of employees, or jointly by employees and employers,
without profit to the operators thereof or to any other person, for the prevention and
treatment of accidental injuries to, and the care of the health of, the employees comprising
26
the group. Employee clinics are specifically exempted from licensure requirements of
H&SC, Division 2, Chapter 1, Clinics. (H&SC Section 1206(n))
Optometric Clinic – Provides comprehensive eye services to patients. It may be licensed
as a Primary Care Clinic or Surgical Clinic. An Optometric Office provides optometric
services, but is not a licensed clinic.
Primary Care Clinic – Clinics specified in H&SC Section 1204 (a) :
Community Clinic – A clinic operated by a tax-exempt nonprofit corporation that is
supported and maintained in whole or in part by donations, bequests, gifts, grants,
government funds or contributions, that may be in the form of money, goods, or services.
In a community clinic, any charges to the patient shall be based on the patient's ability to
pay, utilizing a sliding fee scale. No corporation other than a nonprofit corporation,
exempt from federal income taxation under paragraph (3) of subsection (c) of Section
501 of the Internal Revenue Code of 1954 as amended, or a statutory successor thereof,
shall operate a community clinic; provided, that the licensee of any community clinic so
licensed on the effective date of this section shall not be required to obtain tax-exempt
status under either federal or state law in order to be eligible for, or as a condition of,
renewal of its license. No natural person or persons shall operate a community clinic.
(H&SC Section 1204(a)(1))
Free Clinic – A clinic operated by a tax-exempt, nonprofit corporation supported in
whole or in part by voluntary donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services. In a free clinic there
shall be no charges directly to the patient for services rendered or for drugs, medicines,
appliances, or apparatuses furnished. No corporation other than a nonprofit corporation
exempt from federal income taxation under paragraph (3) of subsection (c) of Section
501 of the Internal Revenue Code of 1954 as amended, or a statutory successor thereof,
shall operate a free clinic; provided, that the licensee of any free clinic so licensed on the
effective date of this section shall not be required to obtain tax-exempt status under
either federal or state law in order to be eligible for, or as a condition of, renewal of its
license. No natural person or persons shall operate a free clinic. (H&SC Section
1204(a)(2))
Psychology Clinic – A clinic which provides psychological advice, services, or treatment to
patients, under the direction of a clinical psychologist as defined in Section 1316.5, and is
operated by a tax-exempt nonprofit corporation which is supported and maintained in whole
or in part by donations, bequests, gifts, grants, government funds, or contributions which
may be in the form of money, goods, or services. In a psychology clinic, any charges to the
patient shall be based on the patient's ability to pay, utilizing a sliding fee scale. No
corporation other than a nonprofit corporation, exempt from federal taxation under
paragraph (3), subsection (c) of Section (501 of the Internal Revenue Code of 1954, as
amended, or a statutory successor thereof, shall operate a psychology clinic. (H&SC
Section 1204.1) Psychology clinics are eligible for licensure pursuant to H&SC, Division 2,
Chapter 1, Clinics, but are not required to be licensed. (H&SC Section 1206.1)
27
Specialty Clinic – Types of clinics specified in H&SC subdivision (b) of Section 1204,
including surgical clinics, chronic dialysis clinics, rehabilitation clinics and alternate birth
centers. Specialty clinics must be licensed by CDPH, except for surgical clinics that are
under a physician’s medical license or corporation.
Surgical Clinic – Provides ambulatory surgical care for patients who remain less than
24 hours. A surgical clinic does not include any place or establishment owned or leased
and operated as a clinic or office by one or more physicians or dentists in individual or
group practice, regardless of the name used publicly to identify the place or
establishment, provided, however, that physicians or dentists may, at their option, apply
for licensure. (H&SC Section 1204(b)(1))
Chronic Dialysis Clinic (ESRD, End-Stage Renal Dialysis) – A clinic that provides
less than 24-hour care for the treatment of patients with end-stage renal disease,
including renal dialysis services. (H&SC Section 1204(b)(2))
Rehabilitation Clinic – A clinic that, in addition to providing medical services directly,
also provides physical rehabilitation services for patients who remain less than 24 hours.
Rehabilitation clinics shall provide at least two of the following rehabilitation services:
physical therapy, occupational therapy, social, speech pathology, and audiology
services. A rehabilitation clinic does not include the offices of a private physician in
individual or group practice. (H&SC Section 1204(b)(3))
Alternative Birth Center (ABC) – A clinic that provides comprehensive perinatal
services and delivery care to pregnant women who remain less than 24 hours at the
facility. (H&SC Section 1204(b)(4))
Health &Safety Code Section 1200 – Statute that pertains to licensed clinics not under a
hospital license.
Health &Safety Code Section 1250– Statute that pertains to “health facilities,” which
include general acute care hospitals, and outpatient clinics under a hospital license.
Hospital Building – Hospital building is any building used for a health facility of a type
required to be licensed pursuant to Section 1250 of the Health and Safety Code. The facility
may also need to comply with NFPA 101 requirements for CMS and JCAHO standards
under the Environment of Care. “Hospital building” does not include any building in which
outpatient clinical services of a health facility licensed pursuant to Section 1250 are provided
that is separated from a building in which hospital services are provided. If any one or more
outpatient clinical services in the building provide services to inpatients, the building shall
not be included as a "hospital building" if those services provided to inpatients represent no
more than 25 percent of the total outpatient visits provided at the building. Hospitals shall
maintain on an ongoing basis, data on the patients receiving services in these buildings,
including the number of patients seen, categorized by their inpatient or outpatient status.
Hospitals shall submit this data annually to the CDPH.
License – A written authorization to operate a health facility and/or clinic issued by the
CDPH.
28
Local – See Local Building Jurisdiction.
Local Building Jurisdiction – City, county, or city and county building department, and fire
authority responsible for enforcing the Title 24, California Building Standards Code.
National Fire Protection Association (NFPA) Standard 101 – Life Safety Code, published
by NFPA. Surveys for compliance to 2000 edition of NFPA 101 are performed by CDPH.
Outpatient Clinical Services of a Licensed Hospital – A service under a hospital license
that provides non-emergency health care services to patients. The clinic needs to be
freestanding and comply with Title 24 requirements including OSHPD 3. NFPA 101
requirements for CMS and JCAHO standards under the Environment of Care may also be
applicable. The number of inpatients may represent no more than 25% of the total number
of patients served by the clinic. Services provided may include those enumerated in H&SC
Section 129730.
OSHPD 3 – Regulations promulgated by OSHPD that apply to licensed clinics and hospital
outpatient clinical services provided in a freestanding nonhospital building. OSHPD 3
regulations and other applicable requirements are found in the following parts of Title 24:
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Part 1, California Administrative Code (CAC), Article 21
Part 2, California Building Code (CBC), including Section 1226
Part 3, California Electrical Code (CEC)
Part 4, California Mechanical Code (CMC), including Tables 4-A and 4-B
Part 5, California Plumbing Code (CPC)
Title 24 – California Code of Regulations (CCR), Title 24, also known as the California
Building Standards Code. Title 24 includes the following parts:
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Part 1, California Administrative Code
Part 2, California Building Code
Part 3, California Electrical Code
Part 4, California Mechanical Code
Part 5, California Plumbing Code
Part 6, California Energy Code
Part 7, California Elevator Safety Construction Code (See CCR, Title 8)
Part 8, California Historical Building Code
Part 9, California Fire Code
Part 10, California Code for Building Conservation
Part 11, California Green Building Standards Code
Part 12, California Reference Standards Code
29
ROLES OF THE AGENCIES INVOLVED
California Medical Board – Responsible for licensing physicians to provide medical care.
California Department of Public Health (CDPH) – Verifies that operational requirements are
met and issues a license to operate a licensed clinic. CDPH also conducts the life safety
portion of the survey, enforcing the 2000 edition of NFPA 101, Life Safety Code. Clinics must
meet both State and Federal standards as a condition of participation in the Medicare program.
Local Building Jurisdiction (LBJ) – Responsible for plan review, building permit issuance,
building construction inspection, and issuance of certificate of occupancy. A written certification
of conformance with OSHPD 3 amendments is required for Surgical and Dialysis Clinics. When
the local building jurisdiction provides certification, it shall certify within 30 days of the
completion of construction that the applicable clinic provisions have been met. The local
building jurisdiction may choose not to provide this certification, requiring submittal to OSHPD
for plan review and certification.
Local fire department – Enforces all fire and life safety requirements Office of the State Fire
Marshal (SFM) in Title 24.
Office of Statewide Health Planning and Development (OSHPD) – In consultation with the
Community Clinics Advisory Committee, OSHPD shall prescribe minimum construction
standards of adequacy and safety for the physical plant of clinics as found in the California
Building Standards Code. Additionally, OSHPD may perform a role in the plan review, building
inspection and certification process as described in Title 24, Part 1, Article 21, “Plan Review,
Building Inspection and Certification of Surgical Clinics, Chronic Dialysis Clinics and Outpatient
Services Clinics.”
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ACRONYMS
ABC
Alternative Birthing Center
ASC
Ambulatory Surgical Center
CCR
California Code of Regulations
CDPH
California Department of Public Health
CMS
Center for Medicare/Medicaid Services (formerly known as Healthcare Financing
Association (HCFA))
ESRD
End Stage Renal Dialysis
H&SC
Health and Safety Code
JCAHO
Joint Commission Accreditation Hospitals and Organizations known as the Joint
Commission
NFPA
National Fire Protection Association
OSHPD
Office of Statewide Health Planning and Development
SFM
Office of the State Fire Marshal
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2013 CBC Architectural Plan Review Reminder List - OSHPD 3
CHK N/A
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1226 CLINICS
1226.1
Scope
1226.2
Application
1226.2.1
Outpatient clinical services
1226.2.2
Special services
1226.3
Definitions
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1226.4
GENERAL CONSTRUCTION
1226.4.1
Examination and treatment areas
1226.4.1.1
Service spaces
1226.4.1.2
Treatment spaces
1226.4.1.3
Examination or treatment room
1226.4.1.4
Airborne infection isolation exam/treatment room
1226.4.2
Miscellaneous requirements
1226.4.2.1
Station outlets
1226.4.2.2
Gas and vacuum systems
1226.4.2.3
Hyperbaric facilities
1226.4.2.4
Laboratories
1226.4.2.5
Nurse call systems
1226.4.3
Corridors
1226.4.3.1
Outpatient services
1226.4.3.2
Corridor width
1226.4.3.3
Light traffic
1226.4.3.4
Handrails
1226.4.3.5
Connections
1226.4.4
Doors and door openings
1226.4.4.1
Toilet room doors
1226.4.4.2
Pocket doors
1226.4.5
Windows
1226.4.5.1
Window screens
1226.4.5.2
Light and ventilation
1226.4.6
Ceiling heights
1226.4.6.1
Minimum height
1226.4.6.2
Minimum height with fixed ceiling equipment
1226.4.7
Interior finishes
1226.4.7.1
Floor finishes
1226.4.7.1.1
Coved base
1226.4.7.1.2
Wet cleaning
1226.4.7.1.3
Airborne infection isolation exam/treatment room
1226.4.7.2
Wall bases
1226.4.7.2.1
Material
1226.4.7.2.2
Wet cleaning
1226.4.7.3
Wall finishes
1226.4.7.4
Ceilings
1226.4.8
Elevators
1226.4.8.1
Elevator cab requirements
1226.4.8.2
Dimensions
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1226.4.9
1226.4.9.1
1226.4.9.2
1226.4.9.3
1226.4.10
1226.4.11
1226.4.12
1226.4.13
1226.4.13.1
1226.4.13.2
1226.4.13.2.1
1226.4.13.2.2
1226.4.14.3
1226.4.13.4
1226.4.13.5
1226.4.13.6
1226.4.13.6.1
1226.4.13.6.2
1226.4.13.6.3
1226.4.13.7
1226.4.14
1226.4.14.1
1226.4.14.2
1226.4.15
1226.4.15.1
1226.4.16
1226.4.16.1
1226.4.16.1.1
1226.4.16.1.2
1226.4.16.2
1226.4.16.2.1
1226.4.16.2.2
1226.4.17
1226.4.17.1
1226.4.17.2
1226.4.17.3
Garbage, solid waste, medical waste and trash storage
Location
Enclosure
Waste holding room
Compactors
Housekeeping room
Laundry and trash chutes
Support areas for examination and treatment rooms
Administrative center(s) or station(s)
Medication station
Medicine preparation room or area
Self-contained medicine-dispensing unit
Clean utility room
Soiled workroom or soiled holding room
Sterile and pharmaceutical supply storage
Sterilization facilities
Storage
Central sterile supply and sterilizing area
Sterilizers
Nourishment room
Support areas for patients
Patient toilet room(s)
Specimen and/or blood collection facilities
General support services and facilities
Areas for off-site laundry services
Public and administrative areas
Public
Reception
Outpatient waiting rooms
Administrative services
Medical records storage
Equipment and supply storage
Support areas for staff
Staff toilet(s)
Storage for employees
Staff lounge
OUTPATIENT CLINICAL SERVICES OF A HOSPITAL
  1226.5
OUTPATIENT CLINICAL SERVICES OF A HOSPITAL
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GENERAL SUPPORT AREAS FOR OUTPATIENT CLINICAL SERVICES - Requirements for all service types
1226.5.1
Support areas for patients
1226.5.1.1
Patient toilet room(s)
1226.5.1.2
Specimen and/or blood collection facilities
1226.5.2
General support services and facilities
1226.5.2.1
Garbage, solid waste, medical waste, and trash storage
1226.5.2.2
Housekeeping room
1226.5.3
Public and administrative areas
1226.5.3.1
Public area
1226.5.3.1.1
Reception
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1226.5.3.1.2
1226.5.3.1.3
1226.5.3.1.4
1226.5.3.1.5
1226.5.3.2
1226.5.3.2.1
1226.5.3.2.2
1226.5.4
1226.5.4.1
1226.5.4.2
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RADIOLOGICAL/IMAGING SERVICE SPACE
1226.5.5
Radiological/imaging service space
1226.5.5.1
Support spaces for radiological/imaging services
1226.5.5.1.1
Patient toilet room(s)
1226.5.5.1.2
Outpatient change area
1226.5.5.1.3
Staff facilities
1226.5.5.1.4
Handwashing fixtures
1226.5.5.1.5
Imaging storage (active)
1226.5.5.1.6
Medication station
1226.5.5.1.7
Areas for off-site laundry services
1226.5.5.2
Radiation protection
1226.5.6
X-ray examination services
1226.5.7
Computerized tomography (CT) scanning
1226.5.8
Magnetic resonance imaging (MRI)
1226.5.9
Ultrasound
1226.5.10
Mammography
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Outpatient waiting room
Public toilet(s)
Public telephone access
Drinking fountain(s)
Administrative services
Medical records storage
Equipment and supply storage
Support areas for staff
Staff toilet(s)
Storage for employees
GASTROINTESTINAL ENDOSCOPY
1226.5.11
Gastrointestinal endoscopy
1226.5.11.1
Procedure room(s)
1226.5.11.1.1
Space requirements
1226.5.11.1.2
Handwashing fixture
1226.5.11.2
Processing room
1226.5.11.3
Pre-operative patient holding
1226.5.11.4
Post-anesthesia recovery area
1226.5.11.5
Communication system
1226.5.11.6
Support areas for outpatient gastrointestinal endoscopy
1226.5.11.6.1
Control station
1226.5.11.6.2
Medication station
1226.5.11.6.3
Soiled workroom
1226.5.11.6.4
Clean utility room
1226.5.11.6.5
Anesthesia workroom
1226.5.11.6.6
Storage room(s) for equipment and supplies used in gastrointestinal
endoscopy service
1226.5.11.6.7
Staff clothing change areas
1226.5.11.6.8
Housekeeping room
1226.5.11.6.9
Cleanup room
1226.5.11.6.10
Sterile and pharmaceutical supply
34
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  1226.5.11.7.1
Additional support areas for patients
Outpatient change area
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NUCLEAR MEDICINE
1226.5.12
Nuclear medicine
1226.5.12.1
Radiation protection
1226.5.12.2
Nuclear medicine room
1226.5.12.3
Radiopharmacy
1226.5.12.4
Support areas for nuclear medicine services
1226.5.12.4.1
Cleanup
1226.5.12.4.2
Dose administration area
1226.5.12.4.3
Holding
1226.5.12.4.4
Patient dressing rooms
1226.5.12.4.5
Patient toilet room(s)
1226.5.12.4.6
Staff toilet room(s)
1226.5.12.4.7
Handwashing fixtures
1226.5.12.4.8
Control desk and reception
1226.5.12.4.9
Clean linen storage
1226.5.12.4.10
Soiled and contaminated material
1226.5.12.5
Radiotherapy service space
1226.5.12.5.1
Radiation protection
1226.5.12.5.2
Room size(s)
1226.5.12.5.3
General support area
1226.5.12.6
Additional support areas for linear accelerator
1226.5.12.6.1
Mold room
1226.5.12.6.2
Block room
1226.5.12.7
Additional support areas for cobalt room
1226.5.12.7.1
Hot lab
1226.5.12.8
High dose rate brachytherapy room
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CANCER TREATMENT/INFUSION THERAPY
1226.5.13
Cancer treatment/infusion therapy service space
1226.5.13.1
Location
1226.5.13.2
Nurses’ station(s)
1226.5.13.3
Individual patient treatment areas
1226.5.13.4
Handwashing fixtures
1226.5.13.5
Privacy
1226.5.13.6
Medication dispensing
1226.5.13.7
Examination room
1226.5.13.8
Clean utility room
1226.5.13.9
Soiled utility room
1226.5.13.10
Nourishment station
1226.5.13.11
Housekeeping room
1226.5.13.12
Supplies
1226.5.13.13
Storage
1226.5.13.14
Clean linen storage
1226.5.13.15
Patient storage
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PRIMARY CARE CLINICS
1226.6
PRIMARY CARE CLINICS
1226.6.1
Examination area
1226.6.1.1
Examination room(s)
1226.6.2
Support areas for examination rooms
1226.6.2.1
Administrative center or nurse station
1226.6.2.2
Medication station
1226.6.2.3
Clean utility room
1226.6.2.4
Soiled workroom or soiled linen holding
1226.6.3
Support areas for patients
1226.6.3.1
Patient toilet room(s)
1226.6.3.2
Specimen collection and/or blood collection facilities
1226.6.4
General support services and facilities
1226.6.4.1
Garbage, solid waste, medical waste and trash storage
1226.6.4.2
Housekeeping room
1226.6.5
Public and administrative areas
1226.6.5.1
Public area
1226.6.5.1.1
Reception
1226.6.5.1.2
Outpatient waiting room
1226.6.5.1.3
Public toilet(s)
1226.6.5.1.4
Public telephone access
1226.6.5.1.5
Drinking fountain(s)
1226.6.5.2
Administrative services
1226.6.5.2.1
Medical records storage
1226.6.5.2.2
Equipment and supply storage
1226.6.6
Support areas for staff
1226.6.6.1
Staff toilet(s)
1226.6.6.2
Storage for employees
SURGICAL CLINICS
1226.8
SURGICAL CLINICS
1226.8.1
Outpatient surgical service space
1226.8.1.1
Operating room(s)
1226.8.1.2
Preoperative patient holding
1226.8.1.3
Post-anesthesia recovery area
1226.8.2
Support areas for outpatient surgery
1226.8.2.1
Control station
1226.8.2.2
Supervisor’s office or station
1226.8.2.3
Substerile areas
1226.8.2.4
Medication station
1226.8.2.5
Scrub facilities
1226.8.2.6
Clock
1226.8.2.7
Soiled workroom
1226.8.2.8
Clean utility room
1226.8.2.9
Anesthesia workroom
1226.8.2.10
Equipment storage room(s) for equipment and supplies used in outpatient
surgery
  1226.8.2.11
Staff clothing change areas
  1226.8.2.12
Housekeeping room
  1226.8.2.13
Cleanup room
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1226.8.2.14
1226.8.2.15
1226.8.3
1226.8.3.1
1226.8.3.2
1226.8.4
1226.8.4.1
1226.8.4.2
1226.8.5
1226.8.5.1
1226.8.5.1.1
1226.8.5.1.2
1226.8.5.1.3
1226.8.5.1.4
1226.8.5.1.5
1226.8.5.2
1226.8.5.2.1
1226.8.6
1226.8.6.1
1226.8.6.2
Sterile and pharmaceutical supply storage
Sterilization facilities
Support areas for patients
Patient toilet room(s)
Outpatient change area
General support services and facilities
Garbage, solid waste, medical waste and trash storage
Areas for off-site laundry services
Public and administrative areas
Public area
Reception
Outpatient waiting room
Public toilet(s)
Public telephone access
Drinking fountain
Administrative services
Medical records storage
Support areas for staff
Staff toilet(s)
Storage for employees
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CHRONIC DIALYSIS CLINICS
1226.9
CHRONIC DIALYSIS CLINICS
1226.9.1
Examination and treatment rooms
1226.9.1.1
Examination room(s)
1226.9.1.2
Treatment room(s)
1226.9.1.3
Individual patient treatment areas
1226.9.1.4
Reception
1226.9.1.5
Outpatient waiting room
1226.9.1.6
Bloodborne infection isolation room
1226.9.1.7
Airborne infection isolation exam/treatment room
1226.9.1.8
Home training
1226.9.2
Support areas for examination and treatment rooms
1226.9.2.1
Administrative center or nurse station
1226.9.2.1.1
Handwashing fixtures
1226.9.2.2
Medication station
1226.9.2.3
Clean utility room
1226.9.2.4
Soiled workroom or soiled linen holding
1226.9.2.5
Housekeeping room
1226.9.2.6
Nourishment room
1226.9.2.7
Sterilization facilities
1226.9.3
Administrative services
1226.9.3.1
Medical records storage
1226.9.3.2
Equipment and supply storage
1226.9.4
Support areas for patients
1226.9.4.1
Patient toilet room(s)
1226.9.4.2
Patient storage
1226.9.4.3
Specimen collection facilities
1226.9.5
General support services and facilities
1226.9.5.1
Garbage, solid waste, medical waste and trash storage
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1226.9.5.2
1226.9.5.3
1226.9.5.4
1226.9.5.5
1226.9.5.6
1226.9.6
1226.9.6.1
1226.9.6.2
Areas for off-site laundry services
Reprocessing room
Repair room
Mixing room
Water treatment room
Support areas for staff
Staff toilet(s)
Storage for employees
REHABILITATION CLINICS
  1226.10
REHABILITATION CLINICS
SUPPORT AREAS FOR THERAPY SERVICES
  1226.10.1
Support area for patients
  1226.10.1.1
Patient toilet room(s)
  1226.10.2
General support
  1226.10.2.1
Garbage
  1226.10.2.2
Housekeeping
  1226.10.2.3
Areas for off-site laundry services
  1226.10.3
Public and administrative
  1226.10.3.1
Public area
  1226.10.3.1.1
Reception
  1226.10.3.1.2
Outpatient waiting room
  1226.10.3.1.3
Toilet(s)
  1226.10.3.1.4
Drinking fountain
  1226.10.3.1.5
Telephone
  1226.10.3.2
Administrative services
  1226.10.3.2.1
Medical services
  1226.10.3.2.2
Equipment and supply storage
  1226.10.4
Support areas for staff
  1226.10.4.1
Staff toiles(s)
  1226.10.4.2
Storage for employees
REHABILITATION THERAPY SERVICE SPACES
  1226.10.5
Physical therapy service space
  1226.10.6
Occupational therapy service space
  1226.10.7
Speech pathology and/or audiology service
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ALTERNATIVE BIRTHING CLINICS
1226.11
ALTERNATIVE BIRTHING CLINICS
1226.11.1
Birthing service space
1226.11.1.1
Birthing room
1226.11.1.2
Location
1226.11.1.3
Nurse call system
1226.11.1.4
Handwashing stations
1226.11.1.5
Lighting
1226.11.1.6
Window
1226.11.1.7
Privacy
1226.11.1.8
Newborn care area
1226.11.1.9
Examination room
1226.11.2
Support areas for birthing services
1226.11.2.1
Administrative center or nurse station
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1226.11.2.2
1226.11.2.3
1226.11.2.4
1226.11.2.5
1226.11.2.6
1226.11.2.7
1226.11.2.8
1226.11.2.9
1226.11.3
1226.11.3.1
1226.11.4
1226.11.4.1
1226.11.4.2
1226.11.4.3
1226.11.5
1226.11.5.1
1226.11.5.1.1
1226.11.5.1.2
1226.11.5.1.3
1226.11.5.1.4
1226.11.5.1.5
1226.11.5.2
1226.11.5.2.1
1226.11.5.2.2
1226.11.6
1226.11.6.1
1226.11.6.2
1226.11.6.3
1226.11.6.4
Medication station
Clean utility room
Soiled utility or soiled holding room
Crash cart space
Clean-up room
Ice-making equipment
Nourishment room or area
Medical gas outlets
Support areas for mother and newborn
Patient toilet room(s)
General support services and facilities
Housekeeping room
Garbage, solid waste, medical waste and trash storage
Areas for off-site laundry services
Public and administrative areas
Public areas
Reception
Outpatient waiting room
Public toilet(s)
Public telephone
Drinking fountain
Administrative services
Medical records storage
Equipment and supply storage
Support areas for staff
Staff toilet(s)
Storage for employees
Staff lounge
Staff clothing change area
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PSYCHOLOGY CLINICS
1226.12
PSYCHOLOGY CLINICS
1226.12.1
Public and administrative area
1226.12.1.1
Public area
1226.12.1.1.1
Reception
1226.12.1.1.2
Outpatient waiting room
1226.12.1.1.3
Public toilets(s)
1226.12.1.1.4
Drinking fountain
1226.12.1.1.5
Public telephone
1226.12.1.2
Administrative area
1226.12.1.2.1
Medical records storage
1226.12.1.2.2
Equipment and supply storage
NOTE: The purpose of this list is to reduce oversights and to achieve minimum levels of uniformity and
completeness. The use of this reminder list does not constitute a complete plan review. Compliance with all
items on this list does not necessarily assure compliance with all provision and applicable codes and
standards. This reminder list should be used only by persons with a comprehensive knowledge of the
applicable codes and standards.
OSHPD 3 CLINICS
INSPECTION
GUIDELINES
Building Division
City of Palo Alto (CPA)
Building Inspection
285 Hamilton Ave.
Inspection Request: 650 329-2496
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Revision Date: 11/20/2013
General Requirements/Checklist for:
OSHPD 3 Clinics Inspections
Standards
Codes Enforced:
2013 CBC, Palo Alto Municipal Code
(PAMC), OSHPD CANS-PINS
IVR#
The information provided in this document is general and intended as a guide only. Each project is unique and
additional requirements may be enforced as deemed appropriate.
Please be advised
o Failure to complete items below prior to inspection may result in a re-inspection fee.
OSHPD 3 CLINICS
Scope - The following requirements shall apply to:
 Outpatient clinical services of a hospital when provided in a freestanding building;
o Primary care clinics. Primary care clinics include;
 Free clinics,
 Community clinics,
 Employee clinics and
 Optometric clinics.
o Specialty clinics. Specialty clinics include;
 Surgical clinics,
 Chronic dialysis clinics,
 Rehabilitation clinics and
 Alternative birth centers (ABC)
o Psychology clinics. (2013 CBC section 1226.1)
 All new buildings and additions, alterations or repairs to existing buildings, and conversion
of space to a clinic use within existing buildings, subject to licensure by Licensing and
Certification, California Department of Public Health, shall comply with applicable
OSHPD provisions of the California Electrical Code, California Mechanical Code, California
Plumbing Code, California Fire Code, (Parts 3, 4, 5, and 9 of Title 24) and the chapter 12
requirements of the California Building Code.
o OSHPD requirements apply to all facilities described above and are not dependent upon
Occupancy Group designations. (2013 CBC section 1226.2)
Exceptions: See Section 1224.2.
1. Facilities licensed and in operation prior to the effective date of the current triennial
California Building Code shall not be required to institute corrective alterations or
construction to comply with any new requirements imposed thereby or subsequently,
except;
o Where specifically required or
o Where the enforcing agency determines that a definite hazard to health and safety
exists.
o Facilities for which preliminary drawings have been submitted to the enforcing
agency prior to the effective date of this change shall not be required to comply with
such new requirements, provided working drawings are submitted within one year of
the effective date of such new requirements.
OSHPD Requirements Exceptions (continued)
40
2. The provisions of the current triennial California Building Code do not prohibit the use
of;
Alternate space utilization,
New concepts of design,
Treatment techniques,
Equipment and alternate finish materials
provided the intent of the current triennial California Building Code is accommodated
and written approval for such alternative is granted by the enforcing agency.
o Written substantiating evidence in support of the alternate and a written request for
consideration shall be submitted to the enforcing agency.
3. Nothing in the current triennial California Building Code shall prohibit the provisions of
required services from a centralized service facility serving two or more licensed
facilities when approved in writing by the licensing agency.
o Buildings and required spaces for services provided in a separate centralized
services facility shall comply with all applicable provisions of these regulations and
applicable local codes and ordinances for the services so provided.
4. Acute psychiatric hospitals and general acute-care hospitals providing only acute
medical rehabilitation center services may provide for surgical and anesthesia services
to be provided by an outside licensed facility when approved by the licensing agency.
5. When the Corrections Standards Authority, the Department of Corrections or the
Department of Youth Authority determines that a particular requirement for hospitals
located in a correctional facility may compromise the safety, security or protection of
staff, inmates or property, the enforcement agency shall consider an alternate design.
o
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o
o
General construction - Clinics and outpatient clinical services under a hospital license shall
comply with the following provisions wherever applicable. (2013 CBC section 1226.4)
 Service spaces (2013 CBC section 1226.4.1.1 refer to section 1224.4.2)
o Spaces for;
 Dietary,
 Laundry,
 Morgue,
 Ambulance entrance,
 Receiving areas,
 Power plants,
 Mechanical equipment,
 Incinerator,
 Garbage can cleaning,
 Automobile parking and
 Storage areas for garbage, trash and medical gases
o Shall be located and constructed to minimize noise, steam, odors, hazards and
unsightliness in patient-care areas and bedrooms.
 Treatment spaces (2013 CBC section 1226.4.1.2 refer to section 1224.4.3)
o Radiology, laboratory, pharmacy, physical therapy and service spaces serving only
outpatients and similar outpatient service departments shall not be located in ;
 Nursing units,
 Surgical units,
 Perinatal units,
 Nursery areas,
 Central sterilization rooms,
 General Construction – Treatment Spaces (continued)
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 Food-service' areas,
 Power plants,
 Mechanical equipment rooms, m
 Maintenance shops,
 General storage,
 Laundry,
 Employees' dressing or housekeeping facilities.
o Exception: Physical and occupational therapy spaces of a rehabilitation service may
serve both outpatients and inpatients.
 Examination or treatment room (2013 CBC section 1226.4.1.3 refer to section
1224.4.4.1)
o Unless specified elsewhere, if a treatment room or an exam room is provided, it shall
have;
 A minimum clear floor area of 80 square feet,
 The least dimension of which shall be 8 feet.
 The room shall contain a handwashing fixture.
 Airborne infection isolation exam/treatment room (2013 CBC section 1226.4.1.4
refer to section 1224.4.4.1.1)
o When provided, the airborne infection isolation room shall be an exam/treatment room,
shall be labeled with the words "Airborne Infection Room", and provide the following:
1. Capacity. Each airborne infection isolation exam/treatment room shall contain only
one examination table or recliner.
2. Handwashing station. A handwashing station shall be located in each airborne
infection isolation exam/treatment room.
3. Gowning and storage area. An area for gowning and storage of clean and soiled
materials shall be located directly outside or inside the entry door to the airborne
infection isolation exam/treatment room.
4. Doors. Room doors shall be self-closing· and include latching devices.
5. Sealed-tight room. Room perimeter walls, ceiling, floors, doors and penetration
shall be sealed tightly to minimize air infiltration from the outside or from other
spaces.
6. Ventilation. The ventilation shall be provided as required by the California
Mechanical Code for airborne infection isolation room.
 Airborne infection isolation exam/treatment anteroom. An airborne infection
isolation anteroom is not required; however, when an anteroom is provided, it shall meet
the following requirements: (2013 CBC section 1224.4.4.1.1.1)
1. The anteroom shall provide space for persons to don personal protective equipment
before entering the patient room.
2. All doors to the anteroom shall have self-closing devices.
3. The anteroom shall provide storage of personal protective equipment (e.g.
respirators, gowns, gloves) and clean equipment.
4. Ventilation shall be provided in the anteroom as required by the California
Mechanical Code for airborne infection isolation anteroom.
 Station outlets. Station outlets for oxygen, vacuum, and medical air shall comply with
Table 1224.4.6.1. (2013 CBC section 1226.4.2.1 refer to section 1224.4.6.1)
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 Gas and vacuum systems. The design, installation and testing of medical gas and
vacuum systems shall conform to Table 1224.4.6.1 and NFPA 99. (2013 CBC section
1226.4.2.2 refer to section 1224.4.6.2)
 Hyperbaric facilities. The design and construction of hyperbaric facilities shall conform
to NFPA 99. (2013 CBC section 1226.4.2.3 refer to section 1224.4.6.3)
o NFPA 99 General Requirements for Hyperbaric Facilities
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 For Class A chambers located inside a building, the chamber(s) and all ancillary
service equipment shall be protected by 2-hour fire-resistant-rated construction.
(NFPA 99 section 20.2.1.1)
 Free-standing, dedicated buildings containing only a Class A chamber(s) and
ancillary service equipment shall not be required to be protected by 2-hour fireresistant rated construction. (NFPA 99 section 20.2.1.1.1)
 Where building exterior walls form part of the facility boundary, that portion of
the facility boundary shall not require 2-hour fire-resistant-rated construction.
(NFPA 99 section 20.2.1.1.4)
 If there are connecting doors through such common walls of contiguity, they
shall be at least B-label, 1 ½ -hour fire doors. (NFPA 99 section 20.2.1.1.5)
 Chambers for human occupancy, and their supporting systems, shall be designed
and fabricated to meet ANSI/ASME PVHO-I, Safety Standard for Pressure Vessels for
Human Occupancy, by personnel qualified to fabricate vessels under such codes.
(NFPA 99 section 20.2.2.1)
 Occupancy. Hyperbaric chambers shall be classified according to the following
criteria:
1. Class A - Human, multiple occupancy
2. Class B - Human, single occupancy
3. Class C – animal, no human occupancy (NFPA 99 section 20.2.5.2)
 Laboratories. The design and construction of hospital laboratories shall conform to NFPA
99. (2013 CBC section 1226.4.2.4 refer to section 1224.4.6.4)
 NFPA 99 General Requirements for Laboratory Facilities
o NFPA Chapter 11 establishes criteria to minimize the hazards of fire and explosions in
laboratories as defined in NFPA Chapter 3.
 This section is not intended to cover hazards resulting from the misuse of chemicals,
radioactive materials, or biological materials that will not result in fires or explosions.
(NFPA 99 section 11.1.1)
o An evaluation shall be made of hazards that may be encountered during laboratory
operations such operations are begun. The evaluation shall include hazards associated
with following:
1. Properties of the chemicals used
2. Operation of the equipment
3. Nature of the proposed reactions (e.g., evolution of acid vapors or flammable gases)
(NFPA 99 section 11.2.1.1.1)
o Fire Prevention Procedures. Fire prevention procedures shall be established in
accordance with Section 11.8. (NFPA 99 section 11.2.1.2)
o Procedures for laboratory emergencies shall be developed, including the following:
1. Alarm activation
2. Evacuation
3. Equipment shutdown (NFPA 99 section 11.2.1.3.1)
o Procedures shall be developed for control of emergencies that could occur in the
laboratory, including detailed plans for control operations by an emergency control
group within the organization or a public fire department. (NFPA 99 section 11.2.1.3.2)
o Construction of laboratories shall comply with the requirements of NFPA 45, Standard
on Fire Protection for Laboratories Using Chemicals, NFPA 101, Life Safety Code, and
with the additional requirements of 11.3.1.1.1 and 11.3.1.1.2. (NFPA 99 section
11.3.1.1)
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 NFPA 99 General Requirements for Laboratory Facilities (continued)
o Exit Details.
 Any room arranged for laboratory work that has an area in excess of 1000 sq. ft.
shall have at least two exit access doors remote from each other, one of which shall
open directly on to a means of egress. (NFPA 99 section 11.3.2.1)
 A second means of access to an exit shall be provided for any laboratory work areas
in which hazards exist as required by 3.4.1 of NFPA 45, Standard on Fire Protection
for Laboratories Using Chemicals. (NFPA 99 section 11.3.2.2)
 Travel distance between any point in a laboratory unit and an exit access door shall
not exceed 75ft. (NFPA 99 section 11.3.2.3)
 Nurse call systems. The location of nurse call devices shall comply with Table
1224.4.6.5.
o The design of call systems shall comply with the California Electrical Code, Part 3 of
Title 24. (2013 CBC section 1226.4.2.5 refer to section 1224.4.6.5)
 Outpatient services. Outpatient clinics or outpatient departments which contain facilities
for outpatient use only, such as laboratory, x-ray, physical therapy or occupational therapy,
shall have a minimum corridor or hallway width of 5 feet.
o Outpatient clinics and outpatient departments consisting only of;
 Waiting rooms,
 Business offices,
 Doctor's offices, and
 Examining rooms,
 Outpatient services (continued)
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o Where there is no traffic through such area to other services or to exits from the
building, shall have a minimum corridor or hallway width of 44 inches. (2013 CBC
section 1226.4.3.1 refer to section 1224.4.7.3)
 Corridors Width. For clinics with bed/gurney patient(s) the minimum width of corridors
and hallways shall be 8 feet.
Exception: Patient-care corridors and hallways in hospitals for psychiatric care of patients
who are not bedridden shall have a minimum clear and unobstructed width of 6 feet.
o For the purposes of this section, bedridden patients shall be defined as patients
confined to beds who would be transported or evacuated in beds or litters. (2013 CBC
section 1226.4.3.2 refer to section 1224.4.7.1.)
o Light traffic. Service corridors and hallways with anticipated light traffic volume for
nonpatient use may be reduced to a width of 5 feet if approved by the enforcing
agency.
Exception: Corridors and hallways in administrative and business areas may be
reduced to a width of 44 inches. (2013 CBC section 1226.4.3.3 refer to section
1224.4.7.2)
o Handrails for rehabilitation services space. Corridors for patient traffic in areas
providing skilled nursing, intermediate care or rehabilitation services shall be furnished
with a handrail on both sides at a height not less than 30 inches or greater than 36
inches. (2013 CBC section 1226.4.3.4 refer to section 1224.4.7.4)
o Corridor systems shall connect all patient rooms and basic services.
Exception: Covered pedestrian walkways connecting separate buildings are permitted
for ambulatory, psychiatric or chemical dependency patients. (2013 CBC section
1226.4.3.5 refer to section 1224.4.7.5)
 Doors and door openings. (2013 CBC section 1226.4.4)
o Toilet room doors. Doors to toilet rooms shall have an opening of not less than 32
inches clear in width and shall be equipped with hardware which will permit the door to
swing outward or in a manner to negate the need to push against a patient who may
have collapsed within the toilet room. (2013 CBC section 1226.4.4.1 refer to section
1224.4.8.1)
o Pocket doors. Pocket sliding doors are not permitted.
Exception: Administration and business areas. (2013 CBC section 1226.4.4.2 refer to
section 1224.4.8.2)
 Windows (2013 CBC section 1226.4.5)
o Window screens. Windows which may be frequently left in an open position shall be
provided with insect screens of 16 meshes to the inch. (2013 CBC section 1226.4.5.1
refer to section 1224.4.9.4)
o Light and ventilation. All portions of a building used by patients, personnel or other
persons shall be provided with artificial light and a mechanically operated ventilating
system as specified in the California Electrical Code and the California Mechanical Code.
(2013 CBC section 1226.4.5.2 refer to section 1224.4.9.5)
 Ceiling heights (2013 CBC section 1226.4.6)
o Minimum height. The minimum height of ceilings shall be 8 feet (2438 mm).
Exception: Closet, toilet room and bathroom minimum ceiling heights shall not be less
than 7 feet (2013 CBC section 1226.4.6.1 refer to section 1224.4.10.1)
o
 Ceiling heights (continued)
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o Minimum height with fixed ceiling equipment. Operating rooms, emergency
rooms, delivery rooms, radiographic rooms and other rooms containing ceilingmounted, major fixed equipment or ceiling mounted surgical light fixtures shall have
ceiling heights to accommodate the equipment or fixtures and their normal movement.
 Suspended tracks, rails and pipes located in the traffic path for patients in beds
and/or on stretchers, including those in inpatient service areas, shall be not less
than 7 feet above the floor.
Exception: Mobile suspended tracks such as traverse rails for overhead patient lifts
that may be moved out of the traffic path shall provide a clearance of not less than 6
feet, 8 inches above the floor when in use. (2013 CBC section 1226.4.6.2 refer to
section 1224.4.10.2)
 Interior finishes. (2013 CBC section 1226.4.7)
o Floor finishes shall be smooth, waterproof and durable.
 Flooring surfaces shall provide smooth transitions between different floor materials.
 Slip-resistant flooring products shall be used for flooring surfaces in wet areas
(e.g., kitchens, shower and bath areas), ramps, stairways, entries from exterior to
interior space, and other areas as determined by the functional program.
 Joints for floor openings for pipes, ducts and conduits shall be tightly sealed.
 Joints of structural elements shall be similarly sealed.
Exception: Upon written appropriate documented requests, the licensing agency
may grant approval of the installation of carpets. See Table 1224.4.11. (2013 CBC
section 1226.4.7.1 refer to section 1224.4.11.1 and Table 1224.4.11)
o Coved base. Resilient flooring, if used in toilet and bathing rooms, shall be continuous
and extend upward onto the wall at least 5 inches to minimize moisture infiltration.
Wood bases are prohibited except in waiting areas and administration departments.
(2013 CBC section 1226.4.7.1.1 refer to section 1224.4.11.1.1)
o Wet cleaning. In all areas subject to frequent wet-cleaning methods, flooring
materials shall not be physically affected by germicidal or other types of cleaning
solutions. (2013 CBC section 1226.4.7.1.2 refer to section 1224.4.11.1.3)
o Airborne infection isolation exam treatment room. These rooms and anterooms
shall have seamless flooring with integral coved base. (2013 CBC section 1226.4.7.1.3
refer to section 1224.11.1.4)
 Wall bases (2013 CBC section 1226.4.7.2)
o Material. The material and textures of bases and the installation thereof shall be such
as to minimize dust-catching surfaces, moisture, infiltration and the harboring of
vermin.
Exception: In locations where carpet is permitted as a floor finish material, the use of
carpeted base (coved or strip base) up to a maximum height of 5 inches is also
permissible. (2013 CBC section 1226.4.7.2.1 refer to section 1224.4.11.2.1)
o Wet cleaning. Floors and wall bases in operating rooms, delivery rooms, emergency
operating rooms, cast rooms, interventional rooms and special procedure rooms shall
be monolithic and constructed without joints.
 Floors and wall bases of;
 Kitchens,
 Soiled and clean utility rooms,
 Housekeeping rooms with mop sinks,
 Patient, public and staff sanitary facilities and
 Other areas subject to frequent wet cleaning,
o Wet cleaning (continued)
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 Shall also be homogeneous (of a similar material), but may have tightly sealed joints
and shall be constructed without voids at the intersection of floor and wall surfaces.
(2013 CBC section 1226.4.7.2.2 refer to section 1224.4.11.2.2)
 Walls finishes. Wall finishes shall comply with the following requirements:
1. Wall finishes shall be washable. In the vicinity of plumbing fixtures, wall finishes shall
be smooth, scrubbable and water-resistant.
2. Wall finishes in areas such as operating rooms, delivery rooms and trauma rooms shall
be monolithic, scrubbable and able to withstand cleaning with chemicals.
3. Wall finishes in operating rooms, cesarean delivery rooms, isolation rooms and sterile
processing rooms shall be free of fissures, open joints or crevices that may retain or
permit passage of dirt particles.
4. Wall finishes in areas such as clean corridors, central sterile supply spaces, specialized
radiographic rooms and minor surgical procedure rooms shall be washable, smooth and
able to withstand cleaning with chemicals.
5. Wall areas penetrated by pipes, ducts and conduits shall be tightly sealed to minimize
entry of rodents and insects. Joints of structural elements shall be similarly sealed.
6. Wall finish requirements of Section 1224.4.11.3 do not apply to boiler rooms,
mechanical equipment rooms, administration departments, other offices, enclosed
stairways, maintenance shops and similar spaces. (2013 CBC section 1226.4.7.3 refer to
section 1224.4.11.3)
 Ceilings. Ceilings in areas occupied by patients and the public shall be cleanable with the
use of routine housekeeping equipment. Acoustic and lay-in ceiling, where used, shall not
create ledges or crevices.
o Ceiling finishes. Ceiling finishes shall comply with Table 1224.4.11 and the following
requirements:
Semi-restricted areas:
1. Ceiling finishes in semi-restricted areas such as airborne infection isolation
exam/treatment rooms, surgical corridors, central sterile supply spaces and minor
surgical procedure rooms, shall be non-absorptive, non-perforated, capable of
withstanding cleaning with chemicals, and without crevices that can harbor mold
and bacterial growth.
2. If a lay-in ceiling is provided in semi-restricted areas, it shall be gasketed or each
ceiling tile shall weigh at least one pound per square foot to prevent the passage of
particles from the cavity above the ceiling plane into the semi-restricted
environment.
 Perforated, tegular, serrated cut or highly textured tiles are not acceptable.
Restricted areas:
3. Ceilings in restricted areas shall be monolithic with no cracks or perforations.
4. Ceilings in restricted areas shall be scrubbable and able to withstand cleaning and/
or disinfecting chemicals.
5. All access openings in restricted area ceilings shall be gasketed.
Dietary and laundry areas:
1. Provide either a sealed monolithic and scrubbable gypsum board ceiling or a lay-in
ceiling.
2. If a lay-in ceiling is provided, it shall include the following:
a) A rust-free grid.
48
 Ceilings – Dietary and laundry areas (continued)
b) Ceiling tiles that weigh at least one pound per square foot and are smooth,
scrubbable, non-absorptive, non-perforated and able to withstand cleaning with
chemicals. (2013 CBC section 1226.4.7.4 refer to section 1224.4.11.4 and Table
1224.4.11)
 Elevators (2013 CBC section 1226.4.8)
o Elevator cab requirements. Buildings over one story in height with accommodations
or services for patients on floors without grade-level entrance shall provide at least one
elevator in compliance with Section 3002.4. (2013 CBC section 1226.4.8.1)
o
49
 Elevators (continued)
o Dimensions. Elevators used for the routine transport of wheeled stretchers shall have
minimum inside platform dimensions of 5 feet by 8 feet and a minimum clear door
opening of 3 feet 8 inches. (2013 CBC section 1226.4.8.2)
 Garbage, solid waste, medical waste and trash storage. These facilities shall comply
with the appropriate local health and environmental authorities' requirements, California
Department of Public Health requirements for medical waste management, and comply
with the following minimum requirements: (2013 CBC section 1226.4.9)
o Location. A location shall be provided for waste collection and storage with sufficient
space based upon the volume of projected waste and length of anticipated storage.
 The location of compactors, balers, sharps containers, and recycling container
staging at docks or other waste removal areas shall comply with Section 1224.4.2.
(2013 CBC section 1226.4.9.1)
 Service spaces. Spaces for dietary, laundry, morgue, ambulance entrance,
receiving areas, power plants, mechanical equipment, incinerator, garbage can
cleaning, automobile parking and storage areas for garbage, trash and medical
gases shall be located and constructed to minimize noise, steam, odors,
hazards and unsightliness in patient-care areas and bedrooms. (2013 CBC
section 1224.4.2)
o Enclosure. A lockable room or screened enclosure of at least 25 square feet shall be
provided for the washing and cleaning of garbage containers and for the storage of
garbage, trash and other solid wastes. (2013 CBC section 1226.4.9.2)
Exception: This amount of space may not be required by the enforcing agency if there
is a proposed method of handling and storage which requires a lesser amount of space.
Additional space may be required by the enforcing agency when special operations or
collection and disposal methods result in greater than usual accumulation of solid
wastes. The room or screened enclosure shall include the following:
1. Floor and curb. A concrete floor with a curb and with a drain connected to the
sewer.
2. Water. Steam or hot water and cold water supplies in accordance with the
California Plumbing Code.
3. Size. A minimum floor area of not less than 25 square feet, the least dimension of
which shall be 4 feet.
 This amount of space may not be required by the enforcing agency if there is
proposed a method of handling, storage, or cleaning of containers which requires
a lesser amount of space.
 Additional space may be required by the enforcing agency when special
operations or collection and disposal methods result in greater than usual
accumulation of solid wastes.
o Waste holding room. As an alternative to the requirements in Section 1226.4.9.2, a
holding room for medical waste and garbage may be provided. (2013 CBC section
1226.4.9.3)
Exception: This amount of· space may not be required by the enforcing agency if
there is a proposed method of handling and storage which requires a lesser amount of
space.
 Additional space may be required by the enforcing agency when special operations
or collection and disposal methods result in greater than usual accumulation of solid
wastes. The waste holding room shall comply with the following:
1. The waste holding room shall be a minimum of 25 square feet, with the least
dimension of which is 4 feet.
50
Waste holding room (continued)
2. The waste holding room shall have 100 percent exhaust ventilation.
3. All finishes in the waste holding room shall comply with the requirements in
Section 1224.4.11.
4. The waste holding room shall have convenient access to an exterior door.
 Compactors. Trash compactor systems shall meet the drainage and wash-down
requirements under Section 1226.4.9.2, Items 1 and 2. (2013 CBC section 1226.4.10)
Exception: If a dumpster system is proposed, operational procedures for handling and
storage must be specifically approved by the local health officials.
 Housekeeping room. This room shall be a minimum floor area of 15 square feet.
o It shall contain a service sink or floor receptor and provisions for storage of supplies
and housekeeping equipment. (2013 CBC section 1226.4.11 refer to section 1224.4.15)
 Laundry and trash chutes. Gravity-type laundry and trash chutes shall have a minimum
diameter of 2 feet and shall be designed to prevent distribution of airborne contaminating
elements to all floors served. (2013 CBC section 1226.4.12 refer to section 1224.4.16)
 Administrative center(s) or nurse station(s). This area shall have space for counters
and storage and shall have convenient access to handwashing fixtures (refer to the
California Plumbing Code for definition of handwashing fixture).
o It may be combined with or include centers for reception, charting and communication.
(2013 CBC section 1226.4.13.1)
o Handwashing Fixture [OSHPD 1, 2, 3 & 4] (2013 California Plumbing Code section
210 Definitions). Handwashing fixtures consist of faucet, trim and sink as described:
1. Faucets and Trim
a) Hand washing fixtures used by medical and nursing staff, patients, and food
handlers shall be trimmed with valves that can be operated without the use of
hands.
 Wrist or elbow blades shall be permitted where allowed per Table 4-2.
 Blade handles used for this purpose shall be at least 4 inches in length.
b) Sensor operated fixtures shall be capable of functioning during loss of normal
power.
c) Faucets shall not be equipped with an aerator but may be equipped with a nonaerating laminar flow device.
d) If deck-mounted manual temperature controls are used they shall use wrist
blades at least 4 inches in length.
e) Faucets shall be equipped with gooseneck spouts.
 A gooseneck spout is a deck or fixture-mounted spout so the discharge point
of the spout return is at least 5 inches above the fixture rim.
2. Sinks
a) Sinks in handwashing fixtures shall be designed and installed to prevent
splashing outside of the sink.
b) Sinks shall have well-fitted and sealed basins to prevent water leaks onto or into
the cabinetry or wall spaces.
c) Design of sinks and cabinetry shall not permit storage beneath the sink basin.
 Medication station. Provision shall be made for distribution of medications. This shall be
done from a medicine preparation room or a self-contained medicine dispensing unit.
(2013 CBC section 1226.4.13.2)
51
Medication station (continued)
o Medicine preparation room or area. When provided, the entry of the medicine
preparation room or area shall be under the visual control of the staff. This may be a
part of the administrative center or nurse station and shall include all of the following:
(2013 CBC section 1226.4.13.2.1)
1. Work counter
2. Sink
3. Lockable refrigerator
4. Convenient access to handwashing fixture
5. Locked storage for biologicals and drugs
When a medicine preparation room or area is to be used to store self-contained
medicine dispensing units, the room shall be designed with adequate space to prepare
medicines with the self-contained medicine-dispensing units present.
o Self-contained medicine-dispensing unit. When provided, the location of a selfcontained medicine-dispensing unit shall be permitted in the clean workroom or at the
administrative center or nurses' station, provided there is adequate security for
medications and adequate lighting to easily identify drugs.
 Convenient access to a handwashing fixture shall be provided. (2013 CBC section
1226.4.13.2.2)
o Clean utility room. A clean utility room shall be provided.
 If the room is used for preparing patient care items, it shall contain: (2013 CBC
section 1226.4.13.3)
1. Work counter
2. Handwashing fixture
3. Storage facilities for clean and sterile supplies
 If the room is used only for storage and holding as part of a system for distribution
of clean and sterile materials, the work counter and handwashing fixture may be
omitted.
 Soiled and clean utility rooms or holding rooms shall be separated and have no
direct connection.
o Soiled workroom or soiled holding room. Soiled workroom or soiled holding room
shall be provided and contain: (2013 CBC section 1226.4.13.4)
1. Clinic sink
Exception: For primary care clinics, a utility sink or patient toilet room equipped
with a bedpan flushing device may be provided in lieu of a clinic sink.
 A utility sink may be used for soaking or rinsing and shall be provided as
appropriate to the method of decontamination used.
2. Handwashing fixture
3. Work counter
4. Storage cabinets
5. A designated area for waste receptacle(s)
6. A designated area for soiled linen receptacle(s)
 Where rooms are used for temporary holding of materials, provisions shall be
made for separate collection, storage, and disposal of soiled materials.
 Soiled and clean utility rooms or holding rooms shall be separated and have no
direct connection.
o Sterile and pharmaceutical supply storage. Separate storage for sterile supplies
and pharmaceutical supplies shall be provided. (2013 CBC section 1226.4.13.5)
52
o Sterilization facilities. When provided, a sterilization facility shall meet the following
applicable requirements: (2013 CBC section 1226.4.13.6)
 Storage. Each facility shall provide space for the storage of disposable sterile
supplies or provide space for sterilization and disinfection equipment. (2013 CBC
section 1226.4.13.6.1)
Exception: Facilities with contractual arrangements for outside autoclaving and
sterilizing services.
 Central sterile supply and sterilizing area. When provided, rooms and spaces
of the central supply and sterilizing area shall comply with the following: (2013 CBC
section 1226.4.13.6.2)
1. Soiled work area. A receiving and gross cleaning area which shall contain work
space and equipment for cleaning medical and surgical equipment and for
disposal of or processing of soiled materials.
2. Clean work area. A clean work area which shall contain work space and
equipment for sterilizing medical and surgical equipment and supplies.
3. Sterilizing and equipment disinfection space.
4. Storage. Space for sterile supplies and unsterile supplies.
 Sterilizers. When provided, all sterilizers and autoclaves which emit system steam
exhaust shall be vented to the outside of the building.
 Such vents shall be independent from the plumbing vent system. (2013 CBC
section 1226.4.13.6.3)
Exception: Small instrument sterilizers.
 Nourishment room. When provided, the nourishment room or area shall have all of the
following: (2013 CBC section 1226.4.13.7)
1. Sink
2. Work counter
3. Refrigerator
4. Storage cabinets
5. Equipment for serving nourishment
6. A handwashing fixture, as defined in section 210 of the 2013 California Plumbing Code,
shall be located in the nourishment room or adjacent to the nourishment area.
 Support areas for patients.
o Patient toilet room(s). Toilet room(s) with a lavatory shall be provided separate from
public use toilet(s) and shall be located to permit access from patient care areas without
passing through publicly accessible areas. (2013 CBC section 1226.4.14.1)
Exception: For primary care clinics where the facility contains no more than three
examination and/or treatment rooms, the patient toilet room shall be permitted to serve
outpatient waiting room(s).
o Specimen and/or blood collection facilities. (2013 CBC section 1226.4.14.2 refer
to Section 1224.4.4.2.)
 Specimen collection facilities. When provided, specimen collection facilities shall
comply with the following requirements:
1. Urine collection rooms shall be equipped with a water closet and handwashing
station.
Exception: The handwashing station may be located immediately outside the
collection room when the specimen is used for drug testing.
2. Use of the toilet room provided within the examination and treatment room shall
be permitted for specimen collection. (2013 CBC section 1224.4.4.2.1)
53
Specimen collection facilities (continued)
 Blood collection facilities. When provided, blood collection facilities shall comply
with the following requirements:
1. Space for a chair and work counter shall be provided.
2. A handwashing station shall be provided. (2013 CBC section 1224.4.4.2.2)
 General support services and facilities. (2013 CBC section 1226.4.15)
o Areas for off-site laundry services. If linen is to be processed off site, the following
shall be provided:
1. Soiled linen holding area or designated and dedicated area for soiled laundry cart.
2. Clean linen storage area that protects linen from soil or damage. (2013 CBC section
1226.4.15.1)
 Public and administrative areas. (2013 CBC section 1226.4.16)
o Reception. A reception and information counter or desk shall be provided. (2013 CBC
section 1226.4.16.1.1)
o Outpatient waiting rooms. Waiting rooms for outpatients shall provide a seating
area and space for wheelchairs and have public corridor access to, or provisions for,
public toilet, drinking fountain and telephone. (2013 CBC section 1226.4.16.1.2 refer to
Section 1224.4.5)
Note: One waiting area may serve more than one department or service.
 Outpatient access. If x-ray examinations are to be performed on outpatients,
outpatient access to the radiological spaces shall not traverse a nursing unit.
Exception: Satellite radiology, laboratory, pharmacy, and physical and occupational
therapy space serving inpatients may be located in nursing units and inpatient
treatment areas.
o Medical records storage. Outpatient clinics shall provide a health record service
which shall comply with the following: (2013 CBC section 1226.4.16.2.1)
1. Work area for sorting and recording records for either paper or electronic media.
2. Storage area for records for either paper or electronic media.
o Equipment and supply storage. General storage facilities for office supplies and
equipment shall be provided. (2013 CBC section 1226.4.16.2.2)
 Staff toilet(s). Provide staff toilet(s) in addition to and separate from, public and patient
facilities.
o The areas shall contain toilet(s) and handwashing fixtures pursuant to the 2013
California Plumbing Code, Table 4-2. (2013 CBC section 1226.4.17.1 – see next page for
Table 4-2)
 Storage for employees. Provide storage for staff personal effects with locking drawers or
cabinets (may be individual desks or cabinets).
o Such storage shall be convenient to individual workstations and shall be staff controlled.
(2013 CBC section 1226.4.17.2)
 Staff lounge. When provided, the lounge shall have adequate space to accommodate
staff. (2013 CBC section 1226.4.17.3)
54
55
TABLE 4-2 MINIMUM PLUMBING FACILITIES
[OSHPD 3]
TABLE 4-2 MINIMUM PLUMBING FACILITIES
[OSHPD 3]
56
Notes:
1. Each department or nursing unit shall be served by a housekeeping room equipped with a service sink. Departments may share service
closets provided the departmental services are compatible.
• A dedicated housekeeping room shall be provided for the following services: Surgical/Catherization, ICU, NICU, nursery, dietary,
renal dialysis and outpatient surgery.
2. Conventional spouts and controls on hot-and cold-water supplies are acceptable.
• Aerators are not permitted.
• Non-aerating laminar flow devices are permitted.
• Nourishment areas shall have a handwashing fixture in or immediately accessible from the nourishment area, in addition to a
nourishment sink.
3. Scrub sinks shall be located outside of sterile procedure rooms.
• A minimum of two scrub sinks shall be provided in a surgical unit containing one operating room.
• Four scrub sinks shall be provided in surgical units containing two operating rooms.
• One additional scrub sink shall be provided per each additional operating room.
4. The scrub sink is in addition to the required number for surgeries.
5. The following fixtures shall be provided in airborne infection or protective environment rooms of hospitals only:
a) Within an adjoining toilet room, a lavatory, a shower containing a seat or a space for a shower chair, and toilet equipped with
bedpan flushing attachment with a vacuum breaker.
b) A handwashing fixture within a separate anteroom.
6. The following fixtures shall be provided in isolation rooms of correctional treatment centers only:
a) Within an adjoining toilet area, a handwashing fixture, a shower containing a seat or a space for a shower chair, and water closet
equipped with bedpan flushing attachment with a vacuum breaker.
b) A handwashing fixture within a separate anteroom.
7. Includes burn center spaces, acute respiratory-care service spaces, and coronary-care service spaces.
8. A toilet room with handwashing fixture shall directly adjoin each procedure room.
9. One toilet with lavatory and one shower may serve two labor rooms.
10. One additional scrub sink for each additional cesarean or delivery operating room.
11. Provide emergency eye-wash and shower.
12. Conveniently located for staff use.
57
Notes: (continued)
TABLE 4-2 MINIMUM PLUMBING FACILITIES
[OSHPD 3]
13. Fixtures serving individual patient rooms shall not be considered as meeting the required ratios for bedrooms not served by individual
adjoining toilet or bathrooms.
14. The clinic sink may be deleted if all bedrooms in the nursing unit are provided with adjoining toilets with bedpan flushing devices.
15. Conventional controls on hot-and cold-water supplies are acceptable. The water discharge points shall be 5 inches above the fixture rim.
• Aerators are not permitted.
• Non-aerating laminar flow devices are permitted.
16. A minimum of one bathtub is required on each floor of an acute care or acute psychiatric hospital providing skilled nursing or intermediate
care services.
• Special bathing facilities/gurney shower shall be provided at a minimum ratio of one per 100 beds for acute care facilities.
17. In a multiple-bed room, every bed position shall be within 20 feet of a hands-free handwashing fixture.
• Where an individual room concept is used, a handwashing fixture shall be provided within each infant care room.
18. When three or more procedure rooms are provided.
19. If a separate medicine room is provided, the room shall be equipped with a sink in addition to the nurses' station handwashing fixture.
• Hot-water supplies are optional.
20. Not required when there is a handwashing fixture in the patient bed room.
21. Handwashing fixtures may be deleted if room is used for storage and holding only.
22. If room is used only for temporary holding of soiled materials, clinic sink and work counter may be omitted.
• If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.
23. Toilet shall be equipped with a bedpan flushing attachment.
24. Optional services approved by the licensing agency shall comply with the applicable space requirements of OSHPD 1 and 2.
25. Shall be provided in each separate room where open medication is handled.
26. Conveniently accessible throughout the unit.
27. Includes rooms or areas within coronary and intensive-care units and post-anesthesia recovery rooms.
28. Modular toilet/sink combination units located within a privacy curtain may be used within individual patient space or private room.
• The toilet fixture shall be completely contained within cabinetry when not in use, and shall be enclosed when flushed.
• Bedpan washers shall not be permitted in patient bedrooms.
29. In service spaces with procedure rooms that do not have dedicated patient toilets, provide a minimum of one patient toilet room with a
separate handwashing fixture within the service space.
30. Toilet room shall be accessible from the procedure room.
31. Scrub sink shall be located outside the staff entrance to the procedure room.
32. Not used.
33. Handwashing and scrub sink fixtures shall not be equipped with wrist or elbow blades but shall be equipped with sensor controls, or
controls that do not involve contact with the upper extremities.
34. If room is used only for temporary holding of soiled material, clinic sink and work counter may be omitted.
 OUTPATIENT CLINICAL SERVICES OF A HOSPITAL
o A licensed hospital may elect to locate certain outpatient services in a freestanding
outpatient clinical services building(s).
 To be considered a freestanding outpatient clinical services building the building
must not be physically attached to a building in which inpatient services are
provided.
 No more than 25 percent of the services provided in an outpatient clinical services
building may be rendered to inpatients.
 Services that duplicate the basic services may be provided in freestanding
building(s).
 These services, defined in Subsection (a) of the Health and Safety Code Section
1250, must be in excess of the basic services, necessary for hospital licensure,
required to be located in a hospital building under OSHPD jurisdiction.
o Outpatient clinical services of a hospital in a freestanding outpatient clinical services
building shall comply with Sections 1226.4.2 through 1226.4.8 and the provisions of this
section.
 Outpatient clinical services of a hospital that are not addressed in the provisions of
Section 1226 shall comply with applicable provisions of Section 1224. (2013 CBC
section 1226.5. The majority of these requirements are listed in the
preceding OSHPD 3 Clinics checklist.)
58
 GENERAL SUPPORT AREAS FOR OUTPATIENT CLINICAL SERVICES - Requirements
for all service types.
o Support areas for patients.
 Patient toilet room(s). (2013 CBC section 1226.5.1.1 refer to section
1226.4.14.1)
 Specimen and/or blood collection facilities. (2013 CBC section 1226.5.1.2
refer to section 1224.4.4.2)
o General support services and facilities.
 Garbage, solid waste, medical waste, and trash storage. (2013 CBC section
1226.5.2.1 refer to section 1226.4.9)
 Housekeeping room. (2013 CBC section 1226.5.2.2 refer to section 1224.4.15)
o Public and administrative areas.
 Reception. (2013 CBC section 1226.5.3.1.1 refer to section 1226.4.16.1.1)
 Outpatient waiting room. (2013 CBC section 1226.5.3.1.2 refer to section
1224.4.5)
 Public toilet(s). (2013 CBC section 1226.5.3.1.3 refer to section 1224.4.5)
 Outpatient waiting rooms. Waiting rooms for outpatients shall provide a
seating area and space for wheelchairs and have public corridor access to, or
provisions for, public toilet, drinking fountain and telephone.
 Note: One waiting area may serve more than one department or service (2013
CBC section 1224.4.5)
 Public telephone access. (2013 CBC section 1226.5.3.1.4 refer to section
1224.4.5)
 Drinking fountain(s). (2013 CBC section 1226.5.3.1.5 refer to section 1224.4.5)
 Medical records storage. (2013 CBC section 1226.5.3.2.1 refer to section
1226.4.16.2.1.
 Equipment and supply storage. (2013 CBC section 1226.5.3.2.2 refer to section
1226.4.16.2.2)
 Staff toilet(s). (2013 CBC section 1226.5.4.1 refer to section 1226.4.17.1)
 Storage for employees. (2013 CBC section 1226.5.4.2 refer to section 1226.4.17.2)
 RADIOLOGICAL/IMAGING SERVICE SPACE
o Radiological/imaging service space. When x-ray examination services,
computerized tomography scanning, magnetic resonance imaging, ultrasound, and/or
mammography services are provided, the radiological/imaging services space shall
comply with the provisions of this section. (2013 CBC section 1226.5.5)
 Support spaces for radiological/imaging services. The following spaces are
common to the imaging service area and are minimum requirements: (2013 CBC
section 1226.5.5.1)
 Patient toilet room(s). In service spaces with procedure rooms that do not
require dedicated patient toilets, provide a minimum of one patient toilet room
within the service space, refer to Section 1226.4.14.1. (2013 CBC section
1226.5.5.1.1)
 Outpatient change area. A separate space shall be provided where
outpatients change from street clothing.
• This shall include provisions for clothing storage, space for clothing change
and gowning area.
• Dressing rooms shall be provided convenient to the imaging rooms. (2013
CBC section 1226.5.5.1.2)
 Support spaces for radiological/imaging services. (continued)
59
 Staff facilities. In service space of three or more procedure rooms, staff toilet
room(s) internal to the service space. (2013 CBC section 1226.5.5.1.3)
 Handwashing fixtures. Handwashing fixtures shall be located within the unit.
(2013 CBC section 1226.5.5.1.4)
 Imaging storage (active). If imaging storage systems are used, provide a
means of sorting and filing patient film or electronic media for immediate
retrieval shall be provided. (2013 CBC section 1226.5.5.1.5)
 Medication station. Provision shall be made for locked storage of medications and
drugs. Refer to Section 1226.4.13.2. (2013 CBC section 1226.5.5.1.6)
 Areas for off-site laundry services. Refer to Section 1226.4.15.1. (2013 CBC
section 1226.5.5.1.7)
 Radiation protection. Radiation protection requirements for equipment refer to
Section 1224.18.1.1. (2013 CBC section 1226.5.5.2)
o Radiation protection. A certified physicist or other qualified expert shall specify the
type, location, and amount of radiation protection to be installed in accordance with the
final approved department layout and equipment selections.
 Where protected alcoves with view windows are required, a minimum of 1'-6"
between the view window and the outside partition edge shall be provided.
 Radiation protection requirements shall be incorporated into the
construction documents and;
 Comply with Chapter 31C and;
o California Building Code Chapter 31C requirements:
 Radiation Shielding Barriers
 All radiation shielding barriers in rooms and enclosures housing machines shall
meet the requirements of Section 12-31C-101, Chapter 12-31C, Part 12,
California Referenced Standards Code.
• The Department of Health Services is the only agency that may grant a
variance or exception to these standards.
 Medical Radiographic and Photofluorographic Installations
 Operator station. The operator's station at the control shall be behind a
protective barrier either in a separate room, in a protected booth or behind a
shield which will intercept the useful beam and any radiation which has been
scattered only once. (2013 CBC section 3103C.1)
 Patient observation and communication. Provision shall be made for the
operator to observe and communicate with the patient without leaving the
shielded position at the control panel.
• When an observation window is used, it must provide radiation attenuation
equal to that required in the surrounding barrier. (2013 CBC section 3103C.2)
 Medical Therapeutic Installations
 General. All wall, floor and ceiling areas that can be struck by the useful beam,
plus a border of 1 foot, shall be provided with primary protective barriers. (2013
CBC section 3104C.1)
 Equipment operating above 50 kVp. Equipment operating above 50 kVp
shall conform with the following:
1. The control station shielding shall either be an integral part of the building or
anchored to the building.
 Medical Therapeutic Installations (continued)
60
1. The control station shall be provided with a window having radiation
attenuation equal to that required by the adjacent barrier, or a mirror system,
or a closed-circuit television viewing screen.
• The patient area must be visible to the operator without having to leave
the protected area during exposure. (2013 CBC section 3104C.2)
 Equipment operating above 150 kVp. Equipment operating above 150 kVp
shall conform to the following:
1. The treatment room shall be provided with interlocks so that when any door
of the treatment room is opened,
• Either the machine will shut off automatically or
• The radiation level within the room will be reduced to an average of not
more than 2 milliroentgens per hour and a maximum of 10 milliroentgens
per hour at a distance of one meter in any direction from the target.
• After such shutoff or reduction in output, it shall be possible to restore the
machine to full operation only from the control panel.
2. The control station shall be within a protective booth or in an adjacent room.
(2013 CBC section 3104C.3)
 A minimum of one door shall be provided with an auxiliary means for being
opened in case of power failure or mechanical breakdown, where large powerdriven doors offer the only access to the room. (2013 CBC section 3104C.4)
 A flashing red warning signal light energized only when the useful beam is
on shall be located adjacent to the entrance(s) to a therapy room with
equipment capable of operating above 500 kVp. (2013 CBC section 3104C.5)
o The requirements of California Radiation Control Regulations, California Code of
Regulations, Title 17, Division 1, Chapter 5, and Subchapter 4. (2013 CBC
section 1224.18.1.1)
 Requirements for registration specific to the Department of Public Health.
o X-ray examination services. When provided, x-ray examination services space shall
comply with the following:
1. X-ray room.
2. When shielded control alcove with protective view windows is provided, refer to
Section 1224.18.1.1.
3. Fluoroscopy room, when provided, shall have a toilet room adjoining each
fluoroscopy room, in addition to other toilet room facilities located adjacent to or in
the immediate vicinity.
4. Space for processing images.
5. An office or other suitable area for viewing and reporting radiographic examination.
(2013 CBC section 1226.5.6)
o Computerized tomography (CT) scanning. When provided, CT services space shall
comply with the requirements of Section 1224.18.3. (2013 CBC section 1226.5.7)
 Computerized tomography (CT) scanning. If provided, CT space shall
accommodate the following:
 Spaces required. If provided, CT scan spaces shall accommodate the
equipment with a minimum of 3 feet on all sides of the equipment,
together with the following:
o Computerized tomography (CT) scanning (continued)
61
1. A control room shall be provided that is designed to accommodate the
computer and other controls for the equipment.
• A view window shall be provided to permit view of the patient.
2. A patient toilet room convenient to the procedure room. (2013 CBC section
1224.18.1-18.1.1)
o Magnetic resonance imaging (MRI). When provided, MRJ services space shall
comply with the requirements of Section 1224.18.4. (2013 CBC section 1226.5.8)
 Magnetic resonance imaging (MRI). If provided, the MR1 room shall
accommodate the equipment with a minimum of 3 feet on all sides of the
equipment, together with the following: (2013 CBC section 1224.18.4)
1. A control room shall be provided with full view of the patient in the MRI scanner.
• The control console shall be positioned so the operator has a full view of the
approach and entrance to the MRI scanner room.
2. An anteroom or area visible from the control room shall be located outside the
MRI scanner room so that patients, health care personnel, and other employees
must pass through it before entering the scanning area and control room.
• The room or area shall be outside the restricted areas of the MRI's magnetic
field.
3. A computer room shall be provided.
 Hand-washing station. Hand-washing station(s) shall be provided convenient to
the MRI scanner room, but need not be within the room. (2013 CBC section
1224.18.4.1)
 Wall, floor, and ceiling assemblies. Wall, floor, and ceiling assemblies shall
accommodate the installation of required radio frequency (RF)-shielded assemblies.
• All doors, windows, and penetrations into the RF-shielded enclosure shall be RFshielded.
• As well as RF shielding, individual sites may also require magnetic shielding on
some or all surfaces to contain portions of the magnetic field not contained by
the RF shield. (2013 CBC section 1224.18.4.2)
 Lighted sign. MRI rooms shall be clearly marked with a red light and lighted sign
stating, "The Magnet Is On".
• This light and sign are to be lighted at all times and have a backup energy
source to remain illuminated for at least 24 hours in the event of a loss of power.
(2013 CBC section 1224.18.4.3)
 Magnetic field strength identification. Facilities shall use finishes or markings to
identify the critical values of the magnetic field surrounding the MRI scanner,
including the 5-gauss exclusion zone or other magnetic field strength values that
may impair the operation of equipment. (2013 CBC section 1224.18.4.4)
 Special ventilation requirements. Where superconducting MRI scanners are
installed, an insulated cryogen quench exhaust pipe as well as room exhaust and
pressure equalization shall be provided to protect occupants in the event of a
cryogen breach. (2013 CBC section 1224.18.4.5)
o Ultrasound. When ultrasound is provided, refer to Section 1224.18.5. (2013 CBC
section 1226.5.9)
 Space requirements. (2013 CBC section 1224.18.5.1)
1. Area. Rooms used for ultrasound examination/ treatment shall have a
minimum clear floor area of 120 square feet.
o Ultrasound (continued)
62
2. Clearances. A minimum clear dimension of 3 feet shall be provided on
three sides of the table/stretcher.
 Handwashing fixture. A handwashing fixture shall be provided within the
procedure room. (2013 CBC section 1224.18.5.2)
 Patient toilet(s). A patient toilet shall be directly accessible to the procedure
room. The patient toilet may be permitted to serve more than one procedure room.
(2013 CBC section 1224.18.5.3)
o Mammography. When mammography is provided, refer to Section 1224.18.6. (2013
CBC section 1226.5.10)
 Mammography. When provided, the mammography room shall comply with the
following: (2013 CBC section 1224.18.6)
 Space requirements.
1. Area. Mammography rooms shall be a minimum of 100 square feet.
2. Shielded alcove. Each x-ray room shall include a shielded control alcove.
• For mammography machines with built-in shielding for the operator, omission
of the alcove shall be permitted when approved by the certified physicist.
(2013 CBC section 1224.18.6.1)
 GASTROINTESTINAL ENDOSCOPY
o Gastrointestinal endoscopy. When provided, gastrointestinal endoscopy services
space shall comply with Section 1224.39.3 and the provisions of this section:
(2013 CBC section 1226.5.11)
 Gastrointestinal endoscopy. If gastrointestinal endoscopy is performed in the
outpatient service area, the endoscopy suite shall be divided into a minimum of
three major functional areas:
 The procedure room(s), instrument processing room(s), and patient
holding/preparation and recovery room or area and the following shall be
provided: (2013 CBC section 1224.39.3)
 Space requirements. Procedure rooms shall have a minimum clear floor area of
200 square feet. Room arrangement shall permit a minimum clearance of 3 feet, 6
inches at each side, head, and foot of the gurney/table. (2013 CBC section
1224.39.3.1.1)
 Handwashing fixture. A separate dedicated handwashing station with hands-free
controls shall be available in the procedure room. (2013 CBC section 1224.39.3.1.)
 Dedicated processing room(s) for cleaning and decontaminating instruments
shall be provided. The cleaning area shall allow for flow of instruments from the
contaminated area to the clean assembly area and then to storage. (2013 CBC
section 1224.39.3.2.1)
 The decontamination area shall be equipped with the following:
1. Utility sink(s) shall be provided as appropriate to the method of decontamination
used.
2. One freestanding handwashing station.
3. Work counter space(s). (2013 CBC section 1224.39.3.2.2)
 GASTROINTESTINAL ENDOSCOPY (continued)
o Pre-operative patient holding. A pre-operative patient holding area shall be
provided in accordance with Section 1224.15.2. (2013 CBC section 1224.39.3.3)
63
 Preoperative patient holding area(s). In facilities with two or more operating
rooms, area(s) shall be provided to accommodate gurney patients or sitting space
for ambulatory patients not requiring gurneys.
 These area(s) shall be under the direct visual control of the nursing staff and
may be part of the recovery service space.
 Each gurney station shall be a minimum clear floor area of 80 square
feet and shall have a minimum clearance of 3 feet on the sides of the
gurneys and the foot of the gurney.
 Provisions for patient privacy such as cubicle curtains shall be made. (2013 CBC
section 1224.15.2)
o Post-anesthesia recovery area. A post-anesthesia recovery area shall meet the
requirements of Section 1224.16. (2013 CBC section 1224.39.3.4)
 Post-anesthetic care units (PACUs). Each PACU shall contain;
 A medication station in accordance with Section 1224.14.2.8;
 Handwashing fixtures;
 Nurse control with charting facilities;
 Clinical sink,
 Refrigerator,
 Provisions for bedpan cleaning; and
 Storage space for gurneys, supplies, and equipment.
 Additionally, the design shall provide
 A minimum of 80 square feet for each patient position with
 A clearance of at least 5 feet between patient gurneys and
 A minimum of 4 feet between the sides and the foot of patient gurneys and
adjacent walls or any other fixed obstructions.
 Provisions for patient privacy such as cubicle curtains shall be made.
 In new construction, at least one door to the recovery room shall access directly
from the surgical service space without crossing public corridors.
 Handwashing fixtures shall be provided with at least one for every four
gurneys uniformly distributed to provide equal access from each patient gurney.
(2013 CBC section 1224.16.1)
Exception: In a rural general acute care hospital, when the surgical service space
is not provided, the anesthesia service space is not required. The hospital must
maintain written transfer agreements with one or more general acute care hospitals
that provide surgical and anesthesia services. Written transfer agreements shall be
approved by the Department of Public Health, Licensing and Certification.
o Communication system. A system for emergency communication shall be provided.
(2013 CBC section 1224.39.3.5)
 Support areas for outpatient gastrointestinal endoscopy. (2013 CBC section
1226.5.11.6)
o Control station. Control stations shall be located to permit visual observation of all
traffic into the surgical service space. (2013 CBC section 1226.5.11.6.1 refer to section
1224.15.3.1)
 Support areas for outpatient gastrointestinal endoscopy (continued)
o Medication station. (2013 CBC section 1226.5.11.6.2 refer to section 1226.4.13.2)
64
o Soiled workroom. An enclosed soiled workroom (or soiled holding room that is part of
a system for the collection and disposal of soiled material) for the exclusive use of the
surgical service space shall be provided.
• The soiled workroom shall contain;
 A flushing-rim clinical sink or equivalent flushing-rim fixture,
 A handwashing fixture,
 A work counter, and
 Space for waste receptacles and soiled linen receptacles.
• Rooms used only for temporary holding of soiled material may omit the flushing-rim
clinical sink and work counters.
 However, if the flushing-rim clinical sink is omitted, other provisions for disposal
of liquid waste shall be provided.
• The room shall not have direct connection with operating rooms.
• Soiled and clean utility room or holding rooms shall be separated.
• The soiled workroom shall provide
 24 square feet per operating room up to eight operating rooms and
 Shall have a minimum area of 48 square feet, with no dimension less than 6 feet.
(2013 CBC section 1226.5.11.6.3 refer to section 1224.15.3.7)
o Clean utility room. This room shall not be used for food preparation.
• A clean utility room is required when clean materials are assembled within the
surgical service space prior to use or following the decontamination cycle.
• It shall contain
 A work counter,
 A handwashing fixture,
 Storage facilities for clean supplies, and
 A space to package reusable items.
• The storage for sterile supplies must be separated from this space.
• If the room is used only for storage and holding as part of a system for distribution
of clean supply materials, the work counter and handwashing fixture may be
omitted.
• Soiled and clean utility rooms or holding rooms shall be separated. (2013 CBC
section 1226.5.11.6.4 refer to section 1224.15.3.8)
o Anesthesia workroom. Provide an anesthesia workroom for cleaning, testing and
storing anesthesia equipment.
• This room shall contain work counter(s) and sink(s) and racks for cylinders. (2013
CBC section 1226.5.11.6.5 refer to section 1224.15.3.9)
o 1226.5.11.6.6 Storage room(s) for equipment and supplies used in gastrointestinal
endoscopy service space.
 Equipment storage room(s) for equipment and supplies used in surgical service
space.
• Each surgical service space shall provide sufficient storage area to keep its
required corridor width free of equipment and supplies, but not less than 150
square feet or 50 square feet per operating room, whichever is greater. (2013
CBC section 1226.5.11.6.6 refer to section 1224.15.3.10)
 Support areas for outpatient gastrointestinal endoscopy (continued)
o Staff clothing change areas. Appropriate areas shall be provided for male and
female personnel (orderlies, technicians, nurses and doctors) working within the
surgical service space.
65
The areas shall contain;
 Lockers,
 Showers,
 Toilets,
 Lavatories equipped for handwashing, and
 Space for donning surgical attire.
• These areas shall be arranged to encourage a one-way traffic pattern so that
personnel entering from outside the surgical service space can change and move
directly into the surgical service space. (2013 CBC section 1226.5.11.6.7 refer to
section 1224.15.3.11)
o Housekeeping room.
 7. A housekeeping room shall be provided for the exclusive use of outpatient
surgery.
• It shall be directly accessible from the service area. (2013 CBC section
1226.5.11.6.8 refer to section 1224.39.2, Item 7)
o Cleanup room.
 4. Each surgical unit shall provide a separate cleanup room separated from any
surgical sterilizing facilities.
• The cleanup room shall provide
 24 square feet per operating room up to eight operating rooms and
 Shall have the minimum area of 48 square feet,
 With no dimension less than 6 feet. (2013 CBC section 1226.5.11.6.9 refer to
section 1224.39.2, Item 4)
•
o Sterile and pharmaceutical supply storage. (2013 CBC section 1226.5.11.6.10
refer to section 1226.4.13.5)
o Outpatient change area. A separate space shall be provided where patients change
out of their street clothing and are prepared for the procedure.
• This space shall include provisions for clothing storage, toilet room(s), sink, space
for clothing change and gowning area. (2013 CBC section 1226.5.11.7.1)
 NUCLEAR MEDICINE
o Nuclear medicine. When provided, nuclear medicine services space shall comply with
Section 1224.34 and the provisions of this section: (2013 CBC section 1226.5.12)
o 1226.5.12.1 Radiation protection. When provided, refer to Section 1224.34.1.1.
o Radiation protection. A certified physicist or other qualified expert shall specify the
type, location, and amount of radiation protection to be installed in accordance with the
final approved department layout and equipment selections. (2013 CBC section
1224.34)
 Where protected alcoves with view windows are required, a minimum of 1'-6"
between the view window and the outside partition edge shall be provided.
 Radiation protection requirements shall be incorporated into the
construction documents and;
 Comply with Chapter 31C and;
 NUCLEAR MEDICINE (continued)
o California Building Code Chapter 31C requirements:
 Radiation Shielding Barriers
66
 All radiation shielding barriers in rooms and enclosures housing machines shall
meet the requirements of Section 12-31C-101, Chapter 12-31C, Part 12,
California Referenced Standards Code.
• The Department of Health Services is the only agency that may grant a
variance or exception to these standards.
 Medical Radiographic and Photofluorographic Installations
 Operator station. The operator's station at the control shall be behind a
protective barrier either in a separate room, in a protected booth or behind a
shield which will intercept the useful beam and any radiation which has been
scattered only once. (2013 CBC section 3103C.1)
 Patient observation and communication. Provision shall be made for the
operator to observe and communicate with the patient without leaving the
shielded position at the control panel.
• When an observation window is used, it must provide radiation attenuation
equal to that required in the surrounding barrier. (2013 CBC section 3103C.2)
 Medical Therapeutic Installations
 General. All wall, floor and ceiling areas that can be struck by the useful beam,
plus a border of 1 foot, shall be provided with primary protective barriers. (2013
CBC section 3104C.1)
 Equipment operating above 50 kVp. Equipment operating above 50 kVp
shall conform with the following:
1. The control station shielding shall either be an integral part of the building or
anchored to the building.
2. The control station shall be provided with a window having radiation
attenuation equal to that required by the adjacent barrier, or a mirror system,
or a closed-circuit television viewing screen.
• The patient area must be visible to the operator without having to leave
the protected area during exposure. (2013 CBC section 3104C.2)
 Equipment operating above 150 kVp. Equipment operating above 150 kVp
shall conform to the following:
1. The treatment room shall be provided with interlocks so that when any door
of the treatment room is opened,
• Either the machine will shut off automatically or
• The radiation level within the room will be reduced to an average of not
more than 2 milliroentgens per hour and a maximum of 10 milliroentgens
per hour at a distance of one meter in any direction from the target.
• After such shutoff or reduction in output, it shall be possible to restore the
machine to full operation only from the control panel.
2. The control station shall be within a protective booth or in an adjacent room.
(2013 CBC section 3104C.3)
 A minimum of one door shall be provided with an auxiliary means for being
opened in case of power failure or mechanical breakdown, where large powerdriven doors offer the only access to the room. (2013 CBC section 3104C.4)
 A flashing red warning signal light energized only when the useful beam is
on shall be located adjacent to the entrance(s) to a therapy room with
equipment capable of operating above 500 kVp. (2013 CBC section 3104C.5)
 NUCLEAR MEDICINE (continued)
o The requirements of California Radiation Control Regulations, California Code of
Regulations, Title 17, Division 1, Chapter 5, and Subchapter 4. (2013 CBC
section 1224.18.1.1)
 Requirements for registration specific to the Department of Public Health.
67
o Nuclear medicine room. Sized to accommodate the equipment and a gurney. Provide
a handwashing fixture. (2013 CBC section 1226.5.12.2 refer to section 1224.34.1.2)
o Radiopharmacy. If radiopharmaceutical preparation is performed, an area adequate
to house a radiopharmacy shall be provided with appropriate shielding.
• This area shall include adequate space for storage of radionuclides, chemicals for
preparation, dose calibrators, and record keeping.
• If pre-prepared materials are used, storage and calculation area may be
considerably smaller than that for on-site preparation.
• Space shall provide adequately for dose calibration, quality assurance, and record
keeping.
• The area may still require shielding from other portions of the facilities. (2013 CBC
section 1226.5.12.3 refer to section 1224.34.1.3)
o Support areas for nuclear medicine services. Nuclear medicine area when
operated separately from the imaging department shall provide the following: (2013
CBC section 1226.5.12.4 refer to section 1224.34.2)
 Cleanup. Provisions for cleanup shall be located within the service space for
convenient access and use.
• It shall include service sink or floor receptacle as well as storage space for
equipment and supplies. (2013 CBC section 1226.5.12.4.1 refer to section
1224.34.2.2)
 Dose administration area. Provide and locate near the preparation area.
• Since as much as several hours may elapse for the dose to take effect, the area
shall provide for visual privacy from other areas. (2013 CBC section
1226.5.12.4.2 refer to section 1224.34.2.5)
 Holding. A holding area for patients on gurneys or beds shall be provided out of
traffic and under control of staff and may be combined with the dose administration
area with visual privacy between the areas. (2013 CBC section 1226.5.12.4.3 refer
to section 1224.34.2.6)
 Patient dressing rooms. Located convenient to the waiting area and procedure
rooms.
• Each dressing room shall include
 A seat or bench,
 A mirror, and
 Provisions for hanging patients' clothing and for securing valuables. (2013
CBC section 1226.5.12.4.4 refer to section 1224.34.2.7)
 Patient toilet room(s). Reserved for nuclear medicine patients and shall be
located convenient to waiting and procedure rooms. (2013 CBC section
1226.5.12.4.5 refer to section 1224.34.2.8)
 Staff toilet room(s). Shall be located convenient to the nuclear medicine
laboratory. (2013 CBC section 1226.5.12.4.6 refer to section 1224.34.2.9)
 Handwashing fixtures. Shall be located within each procedure room. (2013 CBC
section 1226.5.12.4.7 refer to section 1224.34.2.10)
 NUCLEAR MEDICINE (continued)
 Control desk and reception. (2013 CBC section 1226.5.12.4.8 refer to section
1226.5.3)
68
 Clean linen storage. A storage area for clean linen shall be provided. (2013 CBC
section 1226.5.12.9)
 Soiled and contaminated material. Provisions with handwashing fixtures shall
be made for holding soiled material.
• Separate provisions shall be made for holding contaminated material. (2013 CBC
section 1226.5.12.4.10 refer to section 1224.34.2.13)
o Radiotherapy service space. When provided, radiotherapy service space shall
comply with the following provisions of this section: (2013 CBC section 1226.5.12.5)
 Radiation protection. (2013 CBC section 1226.5.12.5.1 refer to section
1224.34.3.2 – previously referenced)
 Room sizes. Rooms shall be sized as follows:
1. Cobalt rooms and linear accelerators shall be sized in accordance with equipment
requirements and shall accommodate a gurney for litter borne patients.
• Layouts shall provide for preventing the escape of radioactive particles.
• Openings into the room, including doors, ductwork, vents and electrical
raceways and conduits, shall be baffled to prevent direct exposure to
other areas of the facility.
2. Simulator, accelerator and cobalt rooms shall be sized to accommodate the
equipment with patient access on a gurney, medical staff access to the
equipment and patient, and service access. (2013 CBC section 1226.5.12.5.2
refer to section 1224.34.3.3)
 General support area. The following areas shall be provided:
1. A gurney hold area adjacent to the treatment rooms, screened for privacy, and
combined with a seating area for outpatients.
2. Exam or treatment room shall be provided with a minimum of 100 square feet
with a minimum dimension of 8 feet.
• Each exam room shall be equipped with a handwashing fixture.
Exceptions:
1. Where renovation of existing treatment rooms is undertaken in facilities built
under the 2001 or prior California Building Code, treatment rooms shall have no
less than 80 square feet of clear floor area.
2. For shelled spaces built under the 2001 or prior California Building Code,
treatment rooms shall have no less than 80 square feet of clear floor area per
bed.
3. Darkroom is optional. If provided, shall be convenient to the treatment
room(s)
4. Patient gowning area with provision for safe storage of valuables and clothing
and with direct access to toilet room(s).
• At least one space shall be large enough for staff assisted dressing.
1. Film files area is optional. If provided shall have storage for unprocessed film.
(2013 CBC section 1226.5.12.5.3 refer to section 1224.34.3.4)
o Additional support areas for linear accelerator. (2013 CBC section 1226.5.12.6)
 Mold room. Mold room with exhaust hood and handwashing fixture. (2013 CBC
section 1226.5.12.6.1 refer to section 1224.34.4.1)
 Block room. The block room may be combined with the mold room. (2013 CBC
section 1226.5.12.6.2 refer to section 1224.34.4.2)
o Additional support areas for cobalt room. (2013 CBC section 1226.5.12.7)
 Hot lab. (2013 CBC section 1226.5.12.7.1)
69
o High dose rate brachytherapy room. (2013 CBC section 1226.5.12.8)
 Radiation protection. Cobalt, linear accelerators, hot lab and high dose rate
brachytherapy rooms and simulation rooms require radiation protection.
• All rooms that provide radiation treatment shall be appropriately shielded.
• A certified physicist shall specify the type, location, and amount of protection to
be installed in accordance with final approved department layout and equipment
selection.
• Radiation protection requirements shall
 Be incorporated into the construction documents and
 Comply with Chapter 31 C and
 The requirements of California Radiation Control Regulations, California Code
of Regulations, Title 17, Division 1, Chapter 5, and Subchapter 4. (2013 CBC
section 1224.34.3.2)
 CANCER TREATMENT/INFUSION THERAPY
o Cancer treatment/infusion therapy service space. When provided, cancer
treatment/infusion therapy service space shall comply with the provisions of this
section: (2013 CBC section 1226.5.13)
o Treatment area.
 Location. The treatment area may be an open area and shall be separated from
administrative and waiting areas. (2013 CBC section 1226.5.13.1.1 refer to section
1224.39.4.2.1)
 Nurses' station(s). Shall be located within the cancer treatment/infusion therapy
area and designed to provide visual observation of all patient stations. (2013 CBC
section 1226.5.13.1.2 refer to section 1224.39.4.2.2)
 Individual patient treatment areas. Shall contain at least 80 square feet.
• There shall be at least a 4-foot space around and between beds and/or lounge
chairs used for chemotherapy treatment/infusion. (2013 CBC section
1226.5.13.1.3 refer to section 1224.39.4.2.3)
 Handwashing fixtures. Shall be located convenient to the nurses' station and
patient treatment areas.
• There shall be at least one handwashing fixture serving no more than four
patient stations.
• These shall be uniformly distributed to provide equal access from each patient
station. (2013 CBC section 1226.5.13.1.4 refer to section 1224.39.4.2.4)
 Privacy. The open unit shall be designed to provide privacy for each patient.
(2013 CBC section 1226.5.13.1.5 refer to section 1224.39.4.2.5)
 Medication dispensing. If provided, there shall be a medication dispensing station
for the cancer treatment/infusion therapy area.
• A work counter and handwashing fixture(s) shall be included in the area.
•
•
o Treatment area/Medication dispensing (continued)
•
Provisions shall be made for the controlled storage, preparation, distribution and
refrigeration of medications. (2013 CBC section 1226.5.13.1.6 refer to section
1224.39.4.2.6)
70
 Examination room. An examination room with a handwashing fixture shall be
provided with at least 100 square feet. (2013 CBC section 1226.5.13.1.7 refer to
section 1224.39.4.2. 7)
 Clean utility room. A clean utility room shall be provided.
• If the room is used for preparing patient care items, it shall contain
 A work counter,
 A handwashing fixture, and
 Storage facilities for clean and sterile supplies.
• If the room is used for storage and holding as part of a system for distribution of
clean and sterile materials, the work counter and handwashing fixture may be
omitted.
• Soiled and clean utility rooms or holding rooms shall be separated and have no
direct connection. (2013 CBC section 1226.5.13.1.8 refer to section
1224.39.4.2.8)
 Soiled utility room. A soiled workroom shall be provided and contain
• A sink,
• Handwashing fixture,
• Work counter,
• Storage cabinets,
• Waste receptacles and
• A soiled linen receptacle. (2013 CBC section 1226.5.13.1.9 refer to section
1224.39.4.2.9)
 Nourishment station. If nourishment station for the cancer treatment/infusion
therapy service is provided, the nourishment station shall contain
• A sink,
• A work counter,
• A refrigerator,
• Storage cabinets and
• Equipment for serving nourishment as required. (2013 CBC section
1226.5.13.1.10 refer to section 1224.39.4.2.10)
 Housekeeping room. Adjacent to and for the exclusive use of the unit. (2013 CBC
section 1226.5.13.1.11 refer to section 1224.39.4.2.11)
 Supplies. Supply areas or supply carts shall be provided. (2013 CBC section
1226.5.13.1.12 refer to section 1224.39.4.2.12)
 Storage. Storage space shall be available for wheelchairs and gurneys.
• If gurneys are provided, they shall be out of the direct line of traffic. (2013 CBC
section 1226.5.13.1.13 refer to section 1224.39.4.2.13)
 Clean linen storage. A clean linen storage area shall be provided.
• This may be within the clean utility room, a separate closet, or an approved
distribution system.
• If a closed cart system is used, storage may be in an alcove.
• It must be out of the path of normal traffic and under staff control. (2013 CBC
section 1226.5.13.1.14 refer to section 1224.39.4.2.14)
o Treatment area (continued)
 Patient storage. Storage for patients' belongings shall be provided. (2013 CBC
section 1226.5.13.1.15 refer to section 1224.39.4.3.2)
 PRIMARY CARE CLINICS. Primary care clinics and outpatient clinical services of a
hospital providing services equivalent to a primary care clinic shall comply with Sections
1226.4.3 through 1226.4.8 and the provisions of this section. (2013 CBC section 1226.6)
o Examination area. (2013 CBC section 1226.6.1)
71
 Examination room(s). Unless specified elsewhere, if a treatment room or an
exam room is provided, it shall have a minimum clear floor area of 80 square feet,
the least dimension of which shall be 8 feet.
• The room shall contain a handwashing fixture. (2013 CBC section 1226.6.1.1
refer to section 1224.4.4.1)
o Support areas for examination rooms. (2013 CBC section 1226.6.2)
 Administrative center or nurse station. (2013 CBC section 1226.6.2.1 refer to
section 1226.4.13)
 Medication station. (2013 CBC section 1226.6.2.2 refer to section 1226.4.13.2)
 Clean utility room. (2013 CBC section 1226.6.2.3 refer to section 1226.4.13.3)
 Soiled workroom or soiled linen holding. (2013 CBC section 1226.6.2.4 refer to
section 1226.4.13.4)
o Support areas for patients. (2013 CBC section 1226.6.3)
 Patient toilet room(s). (2013 CBC section 1226.6.3.1 refer to section
1226.4.14.1)
 Specimen collection and/or blood collection facilities. When provided,
specimen collection facilities shall comply with the following requirements:
1. Urine collection rooms shall be equipped with a water closet and handwashing
station.
Exception: The handwashing station may be located immediately outside the
collection room when the specimen is used for drug testing.
2. Use of the toilet room provided within the examination and treatment room shall
be permitted for specimen collection.
 Blood collection facilities. When provided, blood collection facilities shall comply
with the following requirements:
1. Space for a chair and work counter shall be provided.
2. A handwashing station shall be provided. (2013 CBC section 1226.6.3.2 refer to
section 1224.4.4.2-1224.4.4.2.2)
o General support services and facilities. (2013 CBC section 1226.6.4)
 Garbage, solid waste, medical waste and trash storage. (2013 CBC section
1226.6.4.1 refer to section 1226.4.9)
 Housekeeping room. This room shall be a minimum floor area of 15 square feet.
• It shall contain a service sink or floor receptor and provisions for storage of
supplies and housekeeping equipment. (2013 CBC section 1226.6.4.2 refer to
section 1224.4.15)
o Public and administrative areas. (2013 CBC section 1226.6.5)
 Reception. (2013 CBC section 1226.6.5.1.1 refer to section 1226.4.16.1.1)
 Outpatient waiting room. Waiting rooms for outpatients shall provide a seating
area and space for wheelchairs and have public corridor access to, or provisions for,
public toilet, drinking fountain and telephone.
Note: One waiting area may serve more than one department or service.
 Outpatient access. If x-ray examinations are to be performed on outpatients,
outpatient access to the radiological spaces shall not traverse a nursing unit.
Exception: Satellite radiology, laboratory, pharmacy, and physical and occupational
therapy space serving inpatients may be located in nursing units and inpatient
treatment areas. (2013 CBC section 1226.6.5.1.2 refer to section 1224.4.5)
(To be continued)