Ohio Admin. Code 4766-4-15 - Changes to be reported to the board
[Comment: For dates and availability
of material incorporated by reference in this chapter of the Administrative
Code, see rule
4766-4-18
of the Administrative Code.]
(A) Each licensed MTO shall
give written notification to the board within ten
business days
notify the board using the MTLS
online system of any additions, deletions or changes in:
(1) Executive officers or board
members;
(2) Medical director,
including:
(a) Contact information;
and
(b) Medical license
number;
(3) Ownership of
a licensed MTO;
(4) Tax ID or EIN
number;
(5) The name of the primary
contact person(s), business or administrative office telephone number, email
address, and if applicable, office fax number.
(B)
Within ten
days of the date
When a permitted MoICU
or non-transport vehicle is permanently withdrawn from service, the licensed
MTO shall return to the board a "Deletion of
Vehicle" form and
delete the vehicle using the
MTLS online system and remove the decal from the right rear window
and destroy it.
(C) Within ten business days of the date a
licensed MTO ceases to operate, it shall return to the board all vehicle decals
and the certificate of licensure.
(D) Within ten business days of the date a
licensed MTO ceases to operate a satellite base, it shall return to the board
the certificate of licensure.
(E)
A
An MTO
licensed at the MoICU level may apply at any time to be licensed at a lower
level. The application
change shall be made on a
"Change in Level of Service Medical Transportation Organization" form
using the MTLS online system which includes a
and include the one hundred dollar
license fee. The MTO shall also ensure compliance with rules
4766-4-04 and
4766-4-08
of the Administrative Code. A change in level of service does not change the
expiration date of the license.
(F)
A licensed MTO may apply at any time for change of address of headquarters
location. The application
change shall be made on the
"Headquarters Change of Address" form
using the
MTLS online system which includes a
and
include the one hundred dollar license fee. The MTO shall also ensure
compliance with rules
rule 4766-4-04 of the Administrative Code. A change in
headquarters address does not change the expiration date of the
license.
Notes
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04, 4766.07
Prior Effective Dates: 04/16/2012, 08/01/2017
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