§ 15-252. Permit application.

(a)

Applicant shall be a person who seeks to operate a pain management clinic and at least one (1) of the applicants shall be the medical director of the pain management clinic.

(b)

Application for a permit to operate a pain management clinic shall be made to the sustainable development department on a form provided by the sustainable development director. The application for a pain management clinic permit shall, at a minimum, include the following information:

(1)

Florida Department of Health registration number.

(2)

The professional license numbers of the medical director including the Drug Enforcement Agency (DEA) number.

(3)

An accurate legal description of the property on which the pain management clinic is located and street address, and unit number or letter, if any.

(4)

Indicate whether the pain management clinic dispenses controlled substance medication on the pain management clinic location.

(5)

An affidavit by the medical director, attesting to the fact that a background check was performed, evaluated and acted upon to assure that no employees, full-time, part-time, contract, independent or volunteers have been convicted of or who have pled guilty or nolo contendere at any time to an offense constituting a felony in this state or in any other state involving the prescribing, dispensing, supplying, selling or possession of any controlled substance within a five-year period prior to the date of the application.

(6)

A list of all persons associated with the medical and administrative management or operation of the pain management clinic whether paid or unpaid, part time or full time, contract labor or independent contractor and shall include the following information:

a.

Name and title;

b.

Current home address, telephone numbers and date of birth;

c.

Current Florida driver's license or picture identification;

d.

All drug-related criminal convictions.

This list shall be required to be updated within ten (10) days of any new person becoming associated with the pain management clinic.

(7)

A certified survey from a land surveyor registered in the State of Florida, indicating the distance in linear feet between the pain management clinics and pharmacies as measured from the nearest point of the property line of the pain management clinic to the nearest point of the property line to the other pain management clinic and pharmacies in a straight line.

(8)

All information required for a conditional use permit as provided in section 47-24.3 of the ULDR.

(c)

The application for a permit shall be notarized, typewritten, signed and sworn to by the applicant(s) and shall include the post office and physical address of the applicant(s) and the legal property owner(s). The application shall be signed by all applicants. Additionally, the legal property owner(s) on which the pain management clinic is located shall execute a form as provided by the sustainable development department acknowledging that the application has been read and agreed to by the legal property owner(s).

(d)

A separate permit is required for each pain management clinic location. The applicant(s) shall be fully responsible for compliance with this Article IX and each applicant shall be considered a permittee upon the grant of a permit pursuant to this article.

(e)

Pain management clinic permits shall be renewed annually on or before the thirtieth (30th) day of September. A pain management clinic shall update any change in ownership of the pain management clinic or change in medical director of the pain management clinic within ten (10) days to the sustainable development department. The sustainable development department shall review the submitted change information and determine if a new application should be completed based upon the information provided. Any change in location of a pain management clinic shall require a new application be submitted and approved as provided in this article, section 15-253.

( Ord. No. C-11-14, § 1, 6-21-11 ; Ord. No. C-17-28 , § 84, 9-13-17)