Get Fl Dbpr-ddc-224 2016-2025

This guide provides clear and detailed instructions on completing the FL DBPR-DDC-224 application for a permit as a health care clinic establishment. Designed for users of all experience levels, it aims to simplify the online submission process.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the FL DBPR-DDC-224 form online.
2. Begin by selecting the appropriate application type in Section I. Choose between a new application or a new application due to a change in ownership. If applicable, provide the current permit number.
3. In Section II, fill out the applicant information. This includes the taxpayer identification number or federal employer identification number, the full legal name of the business, and any fictitious, trade, or business names, along with the registration number if applicable.
4. Complete the mailing address and physical address sections. Ensure all contact information, including email and phone number, is accurate for quick communication from the department.
5. Designate a qualifying practitioner by providing their contact details and license information. Answer the question regarding their authorization to prescribe and administer prescription drugs.
6. In Section III, outline the type of ownership. Provide the name and address of the registered agent for service of process if required.
7. Detail ownership information by listing all controlling individuals, complete with their names, titles, social security numbers, date of birth, and percentage of ownership.
8. Respond to the background questions in Section IV. If any questions are answered 'Yes', be prepared to provide detailed explanations in Section V.
9. Indicate whether there are other permits or licenses in Section VI. If applicable, provide the names and types of these permits.
10. Finally, review the affidavit in Section VII. Acknowledge your understanding and certifying the application by signing and dating. Ensure to include your printed name and title.
11. Once all sections are completed, save your changes, download the completed form, or print it for submission. Submit the application along with any required documents to the appropriate address.

Complete your application online today to ensure a smooth and efficient process.