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sarogivers requesting issuance of a pain management clinic permit may <br />complete and submit to the department a sworn application, on a form provided <br />by the department, containing, at a minimum, the following information: <br />a. The name and address of the pain management clinic; <br />b. The name and address of the owner of the pain management clinic; <br />c. The name and address of all physicians who will be prescribing controlled <br />substances at the pain management clinic; <br />d. Proof that the pain management clinic meets the definition of a "qualified <br />pain management clinic" which proof may consist of written verification or <br />confirmation from the State of Florida that the pain management clinic is <br />exempt from state registration pursuant to [F.S.] §§ 458.3265(1)(a)2g or h or <br />459.0137(1)(a)2g or h; and <br />e. A sworn statement certifying that the pain management clinic, and every <br />other clinic owned or operated by any person identified pursuant to <br />subsections b or c above, will, during the term of the permit, be operated in <br />compliance with applicable law. <br />(4) Permit Application Fee. A permit application fee shall be paid by the <br />applicant at the time of submittal of the application, including renewal. The <br />amount of the fee shall be set by resolution of the Board. The amount <br />shall be sufficient to recover the County's approximate cost of reviewing <br />and acting upon the application. <br />(5) Denial of Application. The application for a pain management clinic permit <br />shall be denied if any of the following facts are found to exist and are not <br />cured within ten (10) days of written notice of such deficiency: <br />a. The applicant fails to pay the required permit application fee; or <br />b. The applicant fails to submit all information and statements required in <br />subsection (2) or (3) above, or the applicant has submitted such <br />information and statements but such information and statements are found <br />to contain materially false information. <br />(6) Issuance of Permit. The Department shall issue the permit within twenty <br />(20) days of submittal of a fully complete application, if the applicant has <br />submitted all information required in subsection (2) or (3) and none of the <br />facts set forth in subsection (5) is found to exist. <br />RWflomeylLindalG£N£R4LViesolufians & OrdinonreslOrdinancesTain ClinicsRepeaUledical AlanJuanadacr <br />9 <br />