LAC 48:I.7813. Initial Application Process

A. An application packet for licensing as a pain management clinic shall be obtained from the Department of Health and Hospitals. A completed application packet for a clinic shall be submitted to and approved by the department prior to an applicant providing services. B. To be considered complete, the initial licensing application packet shall include the following: 1. the current non-refundable licensing fee pursuant to R. S. 40:2198.13; 2. a copy of the plan review for life safety code and licensing and the on-site inspection report with approvals for occupancy from the OSFM; 3. a copy of the health inspection report with a recommendation for licensure or a recommendation for denial of licensure from the OPH; 4. a zoning approval from local governmental authorities; 5. a statewide criminal background check on all owners conducted by the Louisiana State Police or its designee; 6. verification of the physician owner’s certification in the subspecialty of pain management; 7. proof of professional liability insurance of at least $500,000; a. proof of maintenance of professional liability insurance of at least $500,000 shall be provided to the department at the time of initial licensure, at renewal of licensure, and upon request; 8. an organizational chart identifying the name, position, and title of each person composing the governing body and key administrative personnel; 9. a floor sketch or drawing of the premises to be licensed; and 10. any other documentation or information required by the department for licensure.