§ 18-22. Registration application requirements and process.

(a)

Initiation of application process. Any person seeking to operate a pain management clinic within unincorporated Hernando County shall complete an registration certificate application as provided by the department. The mandatory application materials are specified below in paragraph (b) of this section. An applicant may submit additional materials which the applicant believes are relevant and material to the criteria for approval. An application is granted or denied based upon the facts and evidence submitted as part of the record. An applicant may elect in writing to refuse to submit specified information after a completeness deficiency determination, (See subsection 18-22(c) below), and have the application reviewed against the criteria without the requested information. If any person seeks to operate more than one (1) pain management clinic, a separate application for each clinic shall be required.

(b)

Application materials. As part of the application, the applicant shall provide all of the following information:

(1)

Business name of the clinic, address of the clinic, square footage of the building housing the clinic, opening date, and a description of all existing uses which abut or adjoin the subject site.

(2)

Detailed description of the services and products to be provided, equipment to be used, and a professionally drawn floor plan to scale with all rooms identified.

(3)

Detailed description of all existing and proposed improvements to the subject site.

(4)

A site plan which also shows the total number of parking spaces on the property.

(5)

Evidence of registration with the State of Florida Department of Health pursuant to section 458.3265, Florida Statutes, or other applicable statute, including the State of Florida registration number from the Department of Health as required by chapter 458 or 459, Florida Statues (if the clinic must be registered under state law).

(6)

Proof the applicant has legal ownership of or control of the property that is or is being proposed as a pain management clinic (examples include a copy of the deed if the property is owned by the applicant, a copy of the lease or license agreement if the property is not owned by the applicant).

(7)

For renewal registration certificates pursuant to subsection 18-21(b), proof that the clinic for which the registration certificate is sought was operating within Hernando County as of June 14, 2011. Acceptable forms of proof shall include prior certificate, utility bills, rent receipts, tax returns, or such similar documents as the department may request.

(8)

Designation of the physician who shall be responsible for complying with all requirements related to registration and operation of the clinic and the physician's DEA number. The designated physician must have a full, active, and unencumbered license to practice medicine in Florida, and shall practice at the clinic location for which the physician has assumed responsibility. Within ten (10) days after termination or absence of a designated physician, the clinic must notify the department of the identify of another designated physician for the clinic or forfeit the clinic's certificate of use.

(9)

A list of all persons, including the designated physician, associated with the management and/or operation of the clinic, whether paid or unpaid, part-time or full time, including all contract labor and independent contractors. This list shall include, but is not limited, to all owners, operators, physicians, employees and volunteers. For each and every person listed, the following additional information shall be provided:

a.

The person's full name;

b.

The person's title or position with the clinic (e.g. owner, operator, manager, employee, volunteer etc.);

c.

The person's current home address, telephone number and date of birth;

d.

A copy of the person's current Florida driver's license or a government-issued photo I.D.;

e.

State whether the person has any financial or business interest in a pharmacy, as defined under chapter 465, Florida Statutes; and

f.

A criminal history form or other similar document completed by the sheriff or such persons designated by the sheriff and which indicates whether said person has any criminal conviction(s) including all misdemeanor and felonies and, if so, a listing of said conviction(s). If there are no known criminal convictions, the form shall state same. The sheriff may charge a fee for each criminal background check performed and the applicant shall be responsible for paying said fees. No criminal history form or similar document may be accepted if dated earlier than sixty (60) days from the date filed with the department.

(10)

If during the department's review of the registration certificate application, there is a deletion, substitution or addition of any person listed pursuant to subsection (9) above, the department shall be immediately advised of such change(s) and shall be furnished all of the information required above, including a new criminal history form for each new person that has been substituted or added.

(11)

State whether the pain management clinic prescribes, or intends to prescribe, any controlled substance at the pain management clinic site.

(12)

State whether the pain management clinic dispenses, or intends to dispense, controlled substances at the pain management clinic site.

(13)

State whether the pain management clinic distributes, or intends to distribute controlled substances at the pain management clinic site.

(14)

Such additional information specifically requested by the department as necessary in order for county staff to make a reasonable determination whether to grant or deny the requested registration certificate.

(15)

A sworn and notarized statement, under oath and under penalty of perjury [section 837.02, Florida Statutes] and false official statements [section 827.06, Florida Statutes], from both the designated physician and the clinic owner attesting to the veracity and accuracy of the information provided in the application. The notarized statement shall further attest to all of the following:

a.

That the practice of the designated physician is, or will be, at the location stated in the pain management clinic registration certificate application; and

b.

That no employees of the facility have been convicted of a drug-related crime within the five-year period to the date of application and that the pain management clinic will not knowingly employ any such convicted felons thereafter.

(16)

In the event that any above-required information changes during the department's review, but prior to any decision to grant or deny being made, it shall be the responsibility of the applicant to advise the department of such change(s) within ten (10) calendar days of the change.

(c)

Completeness of application. It is the applicant's sole responsibility to provide accurate contact information when submitting the application to the department. If the application for a pain management clinic registration certificate is not properly completed, in the sole discretion of the department, the department shall notify the designated contact person listed in the application. A completed application must be received by the department within twenty (20) calendar days of receipt of the deficiency notice from the department in order to avoid assessment of another application fee. Failure to timely respond within the twenty (20) days shall result in a denial of the application as incomplete. A new application must then be submitted that is accompanied by the full nonrefundable application fee, in order to request a registration certificate.

(d)

Inspections. Any person authorized to enforce this article, including, but not limited to, law enforcement officers employed by or under the sheriff, upon showing of proper identification, may perform spot or random inspection(s) of the facility as necessary to determine whether or not the application submitted is accurate in all respects, to verify a physician licensed under chapter 458 or 459, Florida Statutes, is on the premises during all times medications are dispensed or prescribed, and/or whether the terms of this article are being adhered to.

(e)

Initial application fee. Each application for a pain management clinic registration certificate shall be accompanied by a nonrefundable application fee in the amount of one thousand five hundred dollars ($1,500.00). The application fee for a pain management clinic registration certificate is in addition to the one-thousand-five-hundred-dollar annual fee/certificate renewal fee. Any changes to the application fee or certificate fee authorized by this article may be accomplished by resolution of the board of county commissioners without the need to revise this article.

(f)

Approval or denial/annual certificate fee. The department shall carefully review and verify the application materials and render a decision to either grant or deny the registration certificate within fifteen (15) business days of receipt of a complete application. Upon approval of its application for a pain management clinic registration certificate in accordance with this article, an applicant shall pay a one-thousand-five-hundred-dollar annual certificate fee to the department. The receipt of the annual registration certificate fee is a prerequisite to the department issuing the registration certificate. The annual registration certificate fee is in addition to, and not in lieu of, the registration certificate application fee of one thousand five hundred dollars ($1,500.00) required pursuant to subsection (d) above.

(g)

Public record. Any information contained in any application under this article is subject to the public records law, chapter 119, Florida Statutes, unless specifically exempted by state law.

(Ord. No. 2012-7, § II, 6-12-12)