Before commencing and/or continuing the establishment and operation of a “pain clinic”, “pain management clinic” or “pain management center” the owner and/or authorized representative of said facility shall apply for a permit to operate said facility by submitting an application to the Portsmouth Department of Health.  Said application shall contain, but not necessarily be limited to, the following:
   (a)   Names, addresses and phone numbers of the owner or owners.
   (b)   If the owner is a corporate entity (i.e., Inc., LLC, S Corp, Partnership, etc) then the individual names, addresses, phone numbers of the stockholders, members and/or partners.
   (c)   The name, address and phone number of the treatment facility.
   (d)   The name, address and phone number of the physician or physicians who are responsible for prescribing or dispensing prescriptions for controlled substances at or from the facility.
   (e)   Written verification that said physicians or physician has malpractice insurance.
   (f)   The name, address and phone number of the supervisor or chief administrative officer of the facility.
   (g)   Written verification that the facility has registered with the Ohio Automated Rx Reporting System (OARRS) of the Ohio Board of Pharmacy.
   (h)   An accompanying license fee of one thousand dollars ($1,000) shall be paid by the applicant.  (Ord. 2011-20.  Passed 3-28-11.)