Указ Губернатора Орловской области от 30.10.2012 № 441

|         | (осуществления) новых работ   |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | (услуг), выданного в          |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | установленном порядке         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | (за исключением перевозки     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | лекарственных средств для     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | медицинского применения)      |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  10.5.  | Реквизиты документа,          | N платежного поручения ___________ __________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|         | подтверждающего факт уплаты   | Дата ______________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | государственной пошлины за    | В размере __________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|         | предоставление лицензии, либо |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | иные сведения, подтверждающие |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | факт уплаты указанной         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | государственной пошлины       |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|   11.   | __* прекращением деятельности по одному адресу или нескольким адресам мест осуществления деятельности, указанным в лицензии                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |
|         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  11.1.  | Реквизиты документа,          | N платежного поручения ____________ ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
|         | подтверждающего факт уплаты   | Дата _____________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         | государственной пошлины за    | В размере __________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|         | предоставление лицензии, либо |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | иные сведения, подтверждающие |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | факт уплаты указанной         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | государственной пошлины       |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  11.2.  | Адрес(а) мест осуществления   | 2. Аптечные организации:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|         | лицензируемого вида           |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | деятельности, на которых      | 2.1. Аптека готовых лекарственных форм                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         | лицензиат прекращает          | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | деятельность.                 |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | Выполняемые работы,           | 2.2. Аптека производственная                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
|         | оказываемые услуги,           | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | составляющие фармацевтическую |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         | деятельность в сфере          |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | обращения лекарственных       | 2.3. Аптека производственная с правом изготовления асептических лекарственных препаратов                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|         | средств для медицинского      | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | применения                    |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 2.4. Аптечный пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 2.5. Аптечный киоск                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                              (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                                              |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3. Структурные подразделения медицинских организаций:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3.1. Аптека готовых лекарственных форм                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               | 3.2. Аптека производственная                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3.3. Аптека производственная с правом изготовления асептических лекарственных препаратов                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3.4. Аптечный пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               | 4. Обособленные подразделения медицинских организаций, расположенных в сельских поселениях, в которых отсутствуют аптечные организации:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 4.1. Центр (отделение) общей врачебной (семейной) практики                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 4.2. Амбулатория                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 4.3. Фельдшерский пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 4.4. Фельдшерско-акушерский пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 5. Индивидуальные предприниматели                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 6. Иные организации, осуществляющие обращение лекарственных средств                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  11.3.  | Дата фактического прекращения |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | деятельности по одному адресу |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | или нескольким адресам мест   |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | осуществления деятельности,   |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | указанным в лицензии          |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|   12.   | __* прекращением деятельности по выполнению работ, оказанию услуг, составляющих лицензируемый вид деятельности и указанных в лицензии                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  12.1.  | Реквизиты документа,          | N платежного поручения _____________ __________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |