(1) The medical director of each pain management clinic shall report annually to the department of health, on a form promulgated by the department, the following: The number of physicians, physician assistants, and advanced practice registered nurses who are working in the clinic for each month;
(2) The number of patients seen by the clinic for each month and the number receiving treatment for chronic nonmalignant pain;
(3) Whether the pain management clinic is part of or associated with a hospital; and
(4) Any other information requested by the department.
(5) The department is authorized to promulgate a reporting form concerning such information as the commissioner may reasonably require, and establish the reporting period and dates for submission.