Renewal Notice - Licensed Clinics
All licensed health care clinics must submit a completed renewal application, with fees, at least 60-days before the license's expiration date.
Failure to timely submit a renewal application and license fee shall result in a $50 per day late fee charged to the licensee by the agency; however, the aggregate amount of the late fee may not exceed 50 percent of the licensure fee or $500, whichever is less. If an application is not received by the Health Care Clinic Unit prior to the expiration date on the license, the clinic will be considered unlicensed and clinic operations cannot resume until a new license is obtained. There are penalties for operating a health care clinic without a valid license. Third-party billing and reimbursement (Medicare, Medicaid, Insurance, etc.) while unlicensed, is unlawful and unenforceable.
***UPDATE*** |
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Renewal Applications - Employer Affidavit of Background Screening Compliance (Effective July 1, 2009) TO BE COMPLETED BY THE EMPLOYER - Affidavit of Compliance with Level 2 Background Screening for Covered Employees For additional information about background screening requirements, Click Here. |
COMPLETE ALL THE FOLLOWING APPLICATIONS:
License Application (AHCA FORM 3110-0013 JULY 06) (Revised July 1, 2009)
Health Care Licensing Application
Health Care Licensing Application Addendum
Surety Bond (New July 2009)
