In Delaware, a Certificate of Public Review (CPR) is required for the following activities:

1. The construction, development or other establishment of a health-care facility or the acquisition of a nonprofit health-care facility.
2. Any expenditure by or on behalf of a health care facility, not including a medical office building, in excess of $5,800,000, which is considered a capital expenditure. Expenditures in excess of $5,800,000 may be exempt from review if they are necessary to maintain the physical structure of a facility and are not directly related to patient care.
3. A change in bed capacity of a health care facility which increases the total number of beds (or distributes beds among various categories, or relocates such beds from one physical or site to another) by more than 10 beds or is more than 10% of total licensed bed capacity, whichever is less, over a 2-year period.
4. The acquisition of major medical equipment ; does not include the replacement of major medical equipment nor major medical equipment acquired by a business or industrial establishment for a dispensary or first aid station, for use by students, employees of a school or university or by inmates and employees of a prison.