THE
HEALTHPLACE
A Private Medical Practice of David P. Kalin, M.D., M.P.H.
P.O. Box 6009
Palm Harbor, Fl 34684
Tel 813.966.1431 Fax 813.925.1932
Thank you for your interest in general supervision with
regard to tattooing and/or permanent makeup.
Please provide the following information on each individual requesting
supervision:
GENERAL INFORMATION
Copy of FLORIDA STATUTE Requirements for registration for general supervision according to Florida Statute 61F6-19.002, Tattooing: General Supervision. (V.10, P.772/61F6-29.002 (2).
Copy of this REGISTRATION page.
Notarized copy of applicant's driver's license.
Copy of Occupational License, if available.
Copies of any educational certificates or
endorsements.
Pictures of the office, equipment, supplies and individual applicant
(dated with signature and office address).
Procedures for sanitation.
Procedures for sterilization.
Procedures for tattooing/permanent makeup technique.
Pictures demonstrating application of procedure, before and after.
Detailed procedures to be followed in the event of an emergency situation
developing during the performance of or as a result of tattooing or permanent
makeup.
Infection control including certification of bio-waste hazards as
applicable and procedure for discarding used needles.
Screening criteria for either selecting or not selecting an appropriate
candidate based on medical history and physical evaluation.
Treatment of routine minor problems resulting during or from tattooing/permanent makeup.
Indicate an understanding of the recommendation to have a base line HIV test and hepatitis immune profile or hepatitis B immunization (indicate status of each).
Any additional information which may be relevant to establishing your
credentials and/or documenting the requirements as stated in Florida Statute
61F6-29.002, Tattooing: General Supervision.
SEMIANNUAL REVIEW
Information regarding HIV testing and hepatitis B
immunization may be obtained at the Public Health Department, one's family
physician or call 813.966.1431 to order and schedule.
The
initial individual registration fee is $495.00, which includes a
REGISTRATION fee of $295.00 and the first
six months of general supervision ($200.00).
In addition to the requirement of "general" supervision this
may include personal direct supervision on a periodic basis as well as
telephonic consultation with regard to the medical aspects of tattooing/permanent makeup.
Upon receipt of the appropriate documentation, an
interview and registration fee, a letter will be issued acknowledging general
supervision of the individual for a period of six months duration.
A request for renewal prior to the six month
(semi-annual) expiration date is the responsibility of each applicant.
Within approximately two weeks of semi-annual expiration a prompting or
reminder letter may be sent on behalf of DAVID P. KALIN, M.D., M.P.H.
One should indicate having reviewed the section entitled
"SEMIANNUAL REVIEW" which is part of the initial registration
materials. The normal semi-annual
renewal fee is $225.00 per applicant. Before the time of the semi-annual renewal any changes in
technique, equipment, office location or procedures should be submitted in
writing in addition to pictures of any of the pertinent additions or changes as
applicable, together with the renewal fee of $225.00, to DAVID P. KALIN, M.D.,
M.P.H., at the above address.
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