7. Clinic Type and Services Clinic Type: all that apply Receives reimbursement from Medicare and/or Medicaid Receives reimbursement from Automobile Personal Injury Protection (PIP) Insurance Mobile Clinic (movable or detached self-contained health care unit within or from which direct health care services are provided) – Portable Equipment Provider– (entity that contracts with or employs persons to provide portable equipment to multiple locations performing treatment or diagnostic testing of individuals) Urgent Care Center – (a facility or clinic that itself out to the general public in any manner as a facility or clinic where immediate but not emergent medical care is provided.) Pain Management Clinic– (registration with the Florida Department of Health will be required) None Apply Provider Services Listing: Check all services to be provided at the clinic Allergy Electrolysis Acupuncture Emergency Medicine Cardiology Endocrinology Chiropractic Medicine End-stage Renal Disease Dentistry Family Medicine Dermatology Gastroenterology Diagnostic Imaging: General Surgery Angiography Geriatrics Arteriography Gynecology Bronchography Hematology CT (Computed Tomography) Hyperbaric Medicine Digital Vascular Imaging Immunology EEG (Electroencephalogram) Infectious Disease EKG/ECG (Electrocardiogram) Infusion Treatment Evoked Potentials Internal Medicine Lymphangiography Laboratory Mammography Midwifery MRI (Magnetic Resonance Imaging) Medication Therapy Management Nerve Conduction Studies Mental Health Services: Nuclear Medicine Clinical Counseling PET (Positron Emission Tomography) Marriage & Family Counseling Splenography Psychiatry Ultrasound Substance/Alcohol Abuse Dietetic/Nutrition Services Other: Naturopathy Rehabilitation Services: Nephrology Massage Therapy Neurology Physical Therapy Neurosurgery Speech Therapy Obstetrics Occupational Therapy Oncology Research/Clinical Trials Ophthalmology Sleep Disorders Optometry Sleep Studies Oral/Maxillo-facial Surgery Sports Medicine
7. Clinic Type and Services Clinic Type: all that apply Receives reimbursement from Medicare and/or Medicaid Receives reimbursement from Automobile Personal Injury Protection (PIP) Insurance Mobile Clinic – (movable or detached self-contained health care unit within or from which direct health care services are provided) Portable Equipment Provider– (entity that contracts with or employs persons to provide portable equipment to multiple locations performing treatment or diagnostic testing of individuals) Urgent Care Center – (a facility or clinic that itself out to the general public in any manner as a facility or clinic where immediate but not emergent medical care is provided.) Pain Management Clinic– (registration with the Florida Department of Health will be required) None Apply Provider Services Listing: Check all services to be provided at the clinic Allergy Electrolysis Acupuncture Emergency Medicine Cardiology Endocrinology Chiropractic Medicine End-stage Renal Disease Dentistry Family Medicine Dermatology Gastroenterology Diagnostic Imaging: General Surgery Angiography Geriatrics Arteriography Gynecology Bronchography Hematology CT (Computed Tomography) Hyperbaric Medicine Digital Vascular Imaging Immunology EEG (Electroencephalogram) Infectious Disease EKG/ECG (Electrocardiogram) Infusion Treatment Evoked Potentials Internal Medicine Lymphangiography Laboratory Mammography Midwifery MRI (Magnetic Resonance Imaging) Medication Therapy Management Nerve Conduction Studies Mental Health Services: Nuclear Medicine Clinical Counseling PET (Positron Emission Tomography) Marriage & Family Counseling Splenography Psychiatry Ultrasound Substance/Alcohol Abuse Dietetic/Nutrition Services Other: Naturopathy Rehabilitation Services: Nephrology Massage Therapy Neurology Physical Therapy Neurosurgery Speech Therapy Obstetrics Occupational Therapy Oncology Research/Clinical Trials Ophthalmology Sleep Disorders Optometry Sleep Studies Oral/Maxillo-facial Surgery Sports Medicine
AHCA3110-0013_HealthCareClinicLicensure_July2014.docx