Florida Regulations 59A-33.002: Licensure, Application Process, General Requirements
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(1) The applicant or licensee shall make application for an initial, change of ownership, or renewal license to operate a health care clinic and shall provide all of the information required by this rule and Florida Statutes Chapter 400, Part X, on the Health Care Licensing Application, Health Care Clinics, AHCA Form 3110-0013, July 2014, incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04945, and available from the Agency for Health Care Administration website at: http://ahca.myflorida.com/HQAlicensureforms.
(2) The following shall be included with the application:
(a) License Fee. A nonrefundable $2,000 application fee payable to AHCA;
(b) Fictitious Name. When an applicant intends to operate under a fictitious name, a copy of an Affidavit of Compliance with Fictitious Name pursuant to Florida Statutes § 865.09, or a copy of a registration form from the Division of Corporations, Secretary of State, showing registration of the applicant’s fictitious name;
(c) Evidence of Incorporation. When an applicant is a corporation or other entity, a copy of the registration of the applicant entity on file with the Division of Corporations, Secretary of State, State of Florida;
(d) Proof of financial ability to operate. Proof of financial ability to operate must be demonstrated for initial licensure and change of ownership applications as required in Florida Statutes § 408.810(8) and Fl. Admin. Code R. 59A-35.062;
(e) Accreditation. Each clinic engaged in magnetic resonance imaging (“”MRI””) services shall provide documentation that it is accredited by a national accrediting organization that is approved by the Centers for Medicare and Medicaid Services for magnetic resonance imaging and advanced diagnostic imaging services within 1 year after licensure or one year after beginning MRI services to patients or placing a new magnet for an existing MRI. This period may be extended in accordance with Section 400.9935(7)(a), F.S.;
(f) Background Screening. Applicants must submit evidence of compliance with level 2 background screening requirements as required in Sections 400.991 and 408.809, F.S.; and,
(g) Medical/Clinic Director Attestation, AHCA Form 3110-1028 (Sept 2014), incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04947, and available from the Agency for Health Care Administration website at: http://ahca.myflorida.com/HQAlicensureforms.
Rulemaking Authority 400.991(1), 400.9925, 408.809, 408.810(8), 408.819 FS. Law Implemented 400.9925, 400.991(1), 408.806, 408.809, 408.810(8) FS. History-New 8-28-06, Amended 2-12-15.
Terms Used In Florida Regulations 59A-33.002
- Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
(a) License Fee. A nonrefundable $2,000 application fee payable to AHCA;
(b) Fictitious Name. When an applicant intends to operate under a fictitious name, a copy of an Affidavit of Compliance with Fictitious Name pursuant to Florida Statutes § 865.09, or a copy of a registration form from the Division of Corporations, Secretary of State, showing registration of the applicant’s fictitious name;
(c) Evidence of Incorporation. When an applicant is a corporation or other entity, a copy of the registration of the applicant entity on file with the Division of Corporations, Secretary of State, State of Florida;
(d) Proof of financial ability to operate. Proof of financial ability to operate must be demonstrated for initial licensure and change of ownership applications as required in Florida Statutes § 408.810(8) and Fl. Admin. Code R. 59A-35.062;
(e) Accreditation. Each clinic engaged in magnetic resonance imaging (“”MRI””) services shall provide documentation that it is accredited by a national accrediting organization that is approved by the Centers for Medicare and Medicaid Services for magnetic resonance imaging and advanced diagnostic imaging services within 1 year after licensure or one year after beginning MRI services to patients or placing a new magnet for an existing MRI. This period may be extended in accordance with Section 400.9935(7)(a), F.S.;
(f) Background Screening. Applicants must submit evidence of compliance with level 2 background screening requirements as required in Sections 400.991 and 408.809, F.S.; and,
(g) Medical/Clinic Director Attestation, AHCA Form 3110-1028 (Sept 2014), incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04947, and available from the Agency for Health Care Administration website at: http://ahca.myflorida.com/HQAlicensureforms.
Rulemaking Authority 400.991(1), 400.9925, 408.809, 408.810(8), 408.819 FS. Law Implemented 400.9925, 400.991(1), 408.806, 408.809, 408.810(8) FS. History-New 8-28-06, Amended 2-12-15.