1. 1. The days and hours of clinical operation and, if different from the days and hours of clinical operation, the days and hours of administrative operation;

2. 2. If applicable, a request to provide one of more of the following:

   1. a. DUI screening,
   2. b. DUI education,
   3. c. DUI treatment, or
   4. d. Misdemeanor domestic violence offender treatment;
3. 3. Whether the counseling facility has an affiliated outpatient treatment center;

4. 4. If the counseling facility has an affiliated outpatient treatment center:

   1. a. The affiliated outpatient treatment center’s name; and

   2. b. Either:

      1. i. The license number assigned to the affiliated outpatient treatment center by the Department; or

      2. ii. If the affiliated outpatient treatment center is not currently licensed, the:

         1. (1) Street address of the affiliated outpatient treatment center, and
         2. (2) Date the affiliated outpatient treatment center submitted to the Department an application for a health care institution license;
5. 5. Whether the counseling facility is sharing administrative support with an affiliated counseling facility; and

6. 6. If the counseling facility is sharing administrative support with an affiliated counseling facility, for each affiliated counseling facility sharing administrative support with the counseling facility:

   1. a. The affiliated counseling facility’s name; and

   2. b. Either:

      1. i. The license number assigned to the affiliated counseling facility by the Department; or

      2. ii. If the affiliated counseling facility is not currently licensed, the:

         1. (1) Street address of the affiliated counseling facility, and
         2. (2) Date the affiliated counseling facility submitted to the Department an application for a health care institution license.

In addition to the license application requirements in A.R.S. § 36-422 and 9 A.A.C. 10, Article 1, a governing authority applying for a license as a counseling facility shall submit, in a format provided by the Department:

Historical Note

New Section made by exempt rulemaking at 20 A.A.R. 3535, pursuant to Laws 2014, Ch. 233, § 5; effective January 1, 2015 (Supp. 14-4). Amended by final rulemaking at 25 A.A.R. 1583, effective October 1, 2019 (Supp. 19-3).