Key takeaways
- Test the proposed clinical use against the building, not just the available square footage.
- Separate landlord promises from documented capacity and written approvals.
- Identify unresolved conditions before setting a construction budget or opening date.
1. What care will actually happen here?
List consultations, procedures, imaging, specimen handling and equipment cleaning separately. Include staff numbers, patient volumes, operating hours and future services. An ordinary examination suite and a licensed specialty clinic can follow different approval paths. Ask the design team and authorities to confirm the facility classification; do not assume every medical office falls under hospital jurisdiction. HCAI's codes and regulations guidance is a useful starting point for that discussion.
2. What do the existing records prove?
Request available permit drawings, previous occupancy approvals, equipment schedules and maintenance information. Compare them with a site walk. A drawing showing a sink or electrical panel is evidence to investigate, not proof that a proposed connection is available. Record inaccessible ceiling spaces and concealed conditions as open items. Agree who pays for surveys, exploratory work and restoration before authorizing them.
3. Is electrical capacity usable where it is needed?
Collect manufacturer requirements for each major device, including voltage, connection type and any backup-power needs. Ask an electrical engineer to assess the existing service, distribution and proposed loads. Empty breaker spaces do not establish spare capacity. Include pathways from the electrical room to the suite and permission to work in shared areas. A technically feasible upgrade can still require landlord or utility coordination outside the tenant's control.
4. Can ventilation and comfort support the program?
Have the mechanical team compare room functions, occupancy, equipment heat and operating hours with the existing systems. Identify shared equipment and any limits on roof access, exhaust discharge or after-hours operation. Ask which areas need separate controls and what testing will confirm performance. Do not prescribe a single ventilation arrangement for every medical use; the clinical program and applicable requirements must guide the design.
5. Where will water and drainage run?
Map proposed handwashing, staff and equipment fixtures against the actual supply and drainage routes. Check whether access below the floor or into another tenant's space may be needed. Equipment-specific water treatment, drainage or connection details belong in the early scope. Ask about shutdown permissions, restoration responsibilities and the process for approving penetrations through shared building elements.
6. Does the accessible route work as a whole?
Review the journey from parking or arrival through the entrance, circulation, reception, treatment areas and restrooms. Do not limit the conversation to a restroom diagram. Alterations can create obligations beyond the room being remodeled; the U.S. Access Board's alterations guide explains why the path of travel deserves early attention. Have qualified designers assess the actual scope and applicable California requirements.
7. Can the equipment reach its final location?
Measure the delivery route, elevator, doorways, turns and installation space. Obtain equipment weights, service clearances and vendor installation requirements before freezing the layout. Decide who receives, stores, places and connects each item. For a hypothetical imaging practice, a suitable room on paper could still fail the delivery-route review. That example illustrates a planning risk, not an HQ project.
8. Who can approve the work?
Build an approval map covering the landlord, building department, fire authority and any healthcare-specific agencies that apply. Confirm the governing code edition and local amendments with the jurisdiction. The California Building Standards Commission publishes state code information. Ask about review dependencies, required consultants and submittal completeness rather than assuming a permit duration from another project.
9. What must the lease and budget account for?
Distinguish tenant work, landlord work, professional services, equipment, temporary operations and contingency. Ask your legal adviser to address approval conditions, access rights and responsibilities in the lease. The construction team should document scope assumptions, not interpret lease protections. A rent commencement date and a realistic opening date are separate decisions that need a coordinated schedule.
A pre-lease decision checklist
- Obtain a written clinical program and equipment list.
- Record capacity findings and missing information by discipline.
- Assign each landlord approval and site investigation to an owner.
- Compare a preferred layout with a simpler fallback option.
- Make the go/no-go decision using documented risks and allowances.
Frequently asked questions
Can a former medical suite be reused without major work?
Possibly, but the former use, current condition and proposed program must be compared. Existing finishes do not prove that systems or approvals suit the new practice.
When should a contractor join the review?
Early enough to test access, sequencing, procurement and scope assumptions alongside the design team. A preliminary review should clearly state its exclusions and unresolved investigations.
