North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 14 - Director, Division of Health Service Regulation
Subchapter E - LICENSURE OF SUITABLE FACILITIES FOR THE PERFOMANCE OF SURGICAL ABORTIONS
Section .0100 - LICENSURE PROCEDURE
Section 14E .0106 - APPLICATION
Universal Citation: 10A NC Admin Code 14E .0106
Current through Register Vol. 39, No. 6, September 16, 2024
(a) Prior to the admission of patients, an applicant for a new clinic shall submit an application for licensure and receive approval from the Division.
(b) Application forms may be obtained by contacting the Division at 2712 Mail Service Center Raleigh, NC 27699-2712.
(c) The application form shall set forth:
(1) Legal identity of
the applicant;
(2) The name or
names under which the facility or services are advertised or presented to the
public;
(3) The facility's mailing
address;
(4) The facility's
physical address;
(5) The ownership
of the facility, including a description of the legal character of the
operating ownership;
(6) The owner
of the premises from which services are offered including the name and address
of the owner of the premises if different from the owner of the
facility;
(7) If the facility is
operated under a management contract, the name and address of the building's
management company;
(8) A
description of the arrangements that have been made for the disposal of
pathological waste, products of conception, and sharps, and the name and
address of the provider of such services if not performed by the
facility;
(9) The name, specialty,
board certifications, and medical license number of the Medical
Director;
(10) The name, specialty,
board certifications, and medical license number of each member of the medical
staff;
(11) The name, nursing
certificate number, and renewal number of the Director of Nursing;
(12) The name, nursing certificate number,
and renewal number of each nursing staff member; and
(13) The name of the consulting pathologist,
the name of the consulting pathologist's laboratory, and the address of the
laboratory.
(d) After construction requirements in Section .0200 of Subchapter 13S of Title 10A of the North Carolina Administrative Code have been met and the application for licensure has been received and approved, the Division shall conduct an on-site, licensure survey.
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