| Applications and appropriate fees should be mailed to:
Laboratory Unit |
Multiphasic Health Testing Centers (MHTC)
Please review recent changes that impact this program.
A new licensure rule became effective July 14, 2010 and new background screening regulations are effective August 1, 2010.
For initial, renewal and *change of ownership applications: Additional Required Forms for Multiphasic Providers FORMS USED BY PROVIDERS AS REQUIRED BY LAW |
NOTE: Agency letters are often sent to applicants by certified mail. All letters are sent to the mailing address provided on the application. After submitting your application, please be prepared to accept and sign for any certified mail sent by the Agency. If the certified letter is sent back to the Agency as undeliverable or, in the case of those sent to the post office box, not accepted or not picked up, the application could be denied.
Regarding Application Fees: Applicants must submit one check separately with each application. Do Not Combine payment for multiple applications into a single check.
If there will be a change of ownership at your facility an application is required to be filed 60 days prior to the effective date of the change. *Change of ownership means:
- An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or
- An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is publicly traded on a recognized stock exchange.
[see s. 408.803(5), Florida Statutes]
NOTE: Change of ownership applications must be filed 60 days prior to the effective date of the change. [see Chapters 408, Part II, and 483, Part I Florida Statutes, 42 CFR 493 and section 59A-7.35, Florida Administrative Code]
Background Screening:
Level 2 Background Screening must be completed for the laboratory director and the chief financial officer prior to approving the initial application and then repeated every five years. Please go to the background screening section of this web site for additional documentation that must be submitted with your application.
Director’s Qualifications
Director qualifications must be submitted for all physician and non - physician laboratory directors.
The State of Florida requirements for laboratory directors can be found at the
Florida Administrative Code (See Chapter 59A-7 for Clinical Laboratory Rules) web site:
http://www.flrules.org/gateway/ChapterHome.asp?Chapter=59A-7
CLIA requirements for directors of moderate complexity testing are at the following link: http://www.phppo.cdc.gov/clia/regs/subpart_m.aspx#493.1405,
CLIA requirements for directors of high complexity testing the requirements are at this link: http://www.phppo.cdc.gov/clia/regs/subpart_m.aspx#493.1443.
| NOTE: If after reviewing the application forms and statutory and rule requirements on our web site you have additional questions, please call (850) 487-3109. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you. |
