1212
. (a) Any person, firm, association, partnership, or
corporation desiring a license for a clinic or a special permit for
special services under the provisions of this chapter, shall file
with the department a verified application on forms prescribed and
furnished by the department, containing the following:
(1) Evidence satisfactory to the department that the applicant is
of reputable and responsible character. If the applicant is a firm,
association, partnership, trust, corporation, or other artificial or
legal entity, like evidence shall be submitted as to the members,
partners, trustees or shareholders, directors, and officers thereof
and as to the person who is to be the administrator of, and exercise
control, management, and direction of the clinic for which
application is made.
(2) If the applicant is a partnership, the name and principal
business address of each partner, and, if any partner is a
corporation, the name and principal business address of each officer
and director of the corporation and name and business address of each
stockholder owning 10 percent or more of the stock thereof.
(3) If the applicant is a corporation, the name and principal
business address of each officer and director of the corporation, and
where the applicant is a stock corporation, the name and principal
business address of each stockholder holding 10 percent or more of
the applicant's stock and, where any stockholder is a corporation,
the name and principal business address of each officer and director
of the corporate stockholder.
(4) Evidence satisfactory to the department of the ability of the
applicant to comply with the provisions of this chapter and rules and
regulations promulgated under this chapter by the department.
(5) The name and address of the clinic, and if the applicant is a
professional corporation, firm, partnership, or other form of
organization, evidence that the applicant has complied with the
requirements of the Business and Professions Code governing the use
of fictitious names by practitioners of the healing arts.
(6) The name and address of the professional licentiate
responsible for the professional activities of the clinic and the
licentiate's license number and professional experience.
(7) The class of clinic to be operated, the character and scope of
advice and treatment to be provided, and a complete description of
the building, its location, facilities, equipment, apparatus, and
appliances to be furnished and used in the operation of the clinic.
(8) Sufficient operational data to allow the department to
determine the class of clinic that the applicant proposes to operate
and the initial license fee to be charged.
(9) Any other information as may be required by the department for
the proper administration and enforcement of this chapter,
including, but not limited to, evidence that the clinic has a written
policy relating to the dissemination of the following information to
patients:
(A) A summary of current state laws requiring child passenger
restraint systems to be used when transporting children in motor
vehicles.
(B) A listing of child passenger restraint system programs located
within the county, as required by Section 27360 or 27362 of the
Vehicle Code.
(C) Information describing the risks of death or serious injury
associated with the failure to utilize a child passenger restraint
system.
(b) (1) No application is required where a licensed primary care
clinic adds a service that is not a special service, as defined in
Section 1203, or any regulation adopted thereunder, or remodels or
modifies an existing primary care clinic site. However, the clinic
shall notify the department, in writing, of the change in service or
physical plant no less than 60 days prior to adding the service or
remodeling or modifying an existing primary care clinic site. Nothing
in this subdivision shall be construed to limit the authority of the
department to conduct an inspection at any time pursuant to Section
1227, in order to ensure compliance with, or to prevent a violation
of, this chapter, or any regulation adopted under this chapter.
(2) Where applicable city, county, or state law obligates the
primary care clinic to obtain a building permit with respect to the
remodeling or modification to be performed by the clinic, the primary
care clinic shall provide a signed certification or statement as
described in Section 1226.3 to the department within 60 days
following completion of the remodeling or modification project
covered by the building permit.
(c) In the course of fulfilling its obligations under Section
1221.09, the department shall ensure that any application form
utilized by a primary care clinic, requiring information of the type
specified in paragraph (1), (4), (8), or (9) of subdivision (a), is
consistent with the requirements of Section 1225, including the
requirement that rules and regulations for primary care clinics be
separate and distinct from the rules and regulations for specialty
clinics. Nothing in this section shall be construed to require the
department to issue a separate application form for primary care
clinics.