How do you get an autorización sanitaria for a clinic in Spain?

Every health centre in Spain, a single doctor's consulta included, needs an operating authorisation from its comunidad autónoma before the first patient. Madrid and Cataluña each decide a complete application within three months, and an application left unanswered in that time is refused.

Who needs an authorisation

Ley 14/1986 requires prior administrative authorisation for the installation and operation of every health centre and establishment, whatever its level, category or owner, and for later changes to its structure.² Real Decreto 1277/2003 sets the national bases. It makes the health authorities of the comunidades autónomas responsible for authorising installation, operation, modification and closure, and the operating authorisation is required before any activity starts.¹ Madrid says any health centre needs one however limited its offer, and asks for an installation authorisation first where there are works and fixed electromedical equipment, such as a dental clinic, X-ray, an operating theatre or a day hospital.³ Cataluña says every centre and service, public or private, needs the Departament de Salut's permission to operate, and the application goes in before activity starts.⁵

What each comunidad asks for

Madrid's application carries the final staff list signed by the Director Técnico Asistencial, every health professional's degree with their colegiación certificate and professional liability insurance, the X-ray register entry where there is X-ray equipment, the electrical installation certificate, the procedures for biological risk accidents and proof of the fee.⁷ A centre without inpatient beds, surgery or fixed equipment in existing premises can file scaled plans instead of a full technical project.⁷ The fee to operate is 96.21 euros for a consulta without X-ray, 318.27 euros with X-ray or simple installations, and 629.11 euros for complex installations such as operating theatres, MRI or CT.⁴

Cataluña's application is online only. It carries the final works certificate or a basic technical project, proof of the right to use the premises, an organigram naming the responsable assistencial, the responsable de vigilància de productes sanitaris and the referent de seguretat del pacient, a current staff list with each degree and colegiación number, the contracts behind them, the equipment list and a plan funcional describing the care offered.⁵ The fee starts at 184.70 euros for a centre without inpatient beds and 431.10 euros with them, plus 28.70 euros for each service.⁵ A consulta mèdica has its own route, one specialty in up to 100 square metres, at a fixed fee of 213.35 euros, and aesthetic medicine, dentistry and telemedicine use other procedures.⁶

1. Classify the centre. Find the centre type and every unit in anexo I of RD 1277/2003, such as C.2.1 consultas médicas or U.48 medicina estética.
2. Check whether works need authorising first. Fixed electromedical equipment in Madrid means an installation authorisation before the operating one.
3. Name the responsible people. The Director Técnico Asistencial in Madrid, the responsable assistencial and patient safety referent in Cataluña.
4. Build the staff file. Every professional's degree, colegiación where it applies and liability insurance, signed off by the responsible person.
5. Pay the fee and file online. Through the Comunidad de Madrid's Cuenta Digital or Tràmits Gencat, with every attachment complete.
6. Open only once it is granted. Silence after three months is a refusal in both comunidades, so plan the opening date around the decision.

1. Comunidad ______ Centre type ______
2. Units in the oferta asistencial ______
3. Responsible person ______ Colegiación number ______
4. Installation authorisation needed ______
5. Staff file complete on ______ Fee paid on ______
6. Application filed on ______ Decision due by ______
7. Opening date ______

Copy template

Classify before you apply

Anexo I of RD 1277/2003 gives every comunidad the same classification of centres and units, from C.2.1 consultas médicas to U.48 medicina estética and U.59 fisioterapia.¹ The authorisation names the centre type and each unit, so a clinic that adds an aesthetic or a physiotherapy unit later changes its oferta asistencial and needs a modificación.¹³

Questions

Can we open while the application is pending?

No, the operating authorisation must be granted before any activity starts, and in both comunidades an unanswered application is refused after three months.

Does a single doctor's consulta need an authorisation?

Yes, a consulta médica is a health centre under RD 1277/2003, and both Madrid and Cataluña authorise it, Cataluña through its own procedure for consultes mèdiques.

What does a Madrid consulta pay?

The fee to operate, renew or modify a consulta without X-ray or fixed electromedical equipment is 96.21 euros.

Sources

1. 1Boletín Oficial del Estado, 2026Real Decreto 1277/2003, de 10 de octubre, por el que se establecen las bases generales sobre autorización de centros, servicios y establecimientos sanitarios, texto consolidadoRead source
2. 2Boletín Oficial del Estado, 2023Ley 14/1986, de 25 de abril, General de Sanidad, texto consolidadoRead source
3. 3Comunidad de Madrid, Consejería de Sanidad, 2026Autorización de centros y servicios sanitariosRead source
4. 4Comunidad de Madrid, Consejería de Sanidad, 2026Autorización de centros, servicios y establecimientos sanitarios, sede electrónicaRead source
5. 5Generalitat de Catalunya, Departament de Salut, 2026Autorització de centres o serveis sanitaris, iniciar l'activitatRead source
6. 6Generalitat de Catalunya, Departament de Salut, 2026Autorització de consultes mèdiques, inici de funcionamentRead source
7. 7Boletín Oficial de la Comunidad de Madrid, 2023Decreto 205/2023, de 19 de julio, por el que se modifica el Decreto 51/2006, de autorización y registro de centros, servicios y establecimientos sanitarios, BOCM 175 of 25 July 2023Read source

Written by the wai team from Health authorities of the Comunidad de Madrid and Cataluña guidance, checked on 16 October 2026. This is guidance, not legal advice. Neither the Comunidad de Madrid's Consejería de Sanidad nor the Generalitat's Departament de Salut endorses wai or any software.