①Where the following persons have applied for permission to establish a hospital, to increase the number of beds, or to alter bed classifications in a hospital, notwithstanding the provisions of paragraph (4) of the preceding Article, the prefectural governor may refuse the permission set forth in paragraph (1) or paragraph (2) of the same Article when, in the area that includes the hospital to which the relevant application relates (where the beds to which the relevant application relates are long-term care beds, etc. only, this is to be the area provided for in Article 30-4, paragraph (2), item (xiv) as prescribed by the medical care plan; where the beds to which the relevant application relates are psychiatric hospital beds, etc. only, this is to be the area of the prefecture; and where the beds to which the relevant application relates are long-term care beds, etc. and psychiatric hospital beds, etc., this is to be the area provided for in Article 30-4, paragraph (2), item (xiv) and the area of the prefecture), the number of hospital or clinic beds that correspond to the classifications of the beds that the relevant application relates to (or the number of long-term care beds and general beds in the relevant area, where the beds that the relevant application relates to are long-term care beds, etc. only) has already reached the target number of beds for the relevant area that correspond to the classifications of the beds that the relevant application relates to (or the target number of beds for long-term care beds and general beds in the relevant area, where the beds that the relevant application relates to are long-term care beds, etc. only), as prescribed in a medical care plan that is in accordance with the requirements prescribed by the Order of the Ministry of Health, Labour and Welfare set forth in paragraph (8) of the same Article, or if it is considered that establishing a hospital, increasing the number of beds, or altering the bed classifications as per the relevant application would exceed the relevant target:

②Where a person listed in any of the items of the preceding paragraph has applied for permission to establish beds in a clinic or to increase the number of beds in a clinic, the prefectural governor may, notwithstanding the provisions of paragraph (4) of the preceding Article, refuse the permission set forth in paragraph (3) of the same Article, when, in the area that includes the clinic to which the relevant application relates (an area provided for in Article 30-4, paragraph (2), item (xiv) as prescribed by the medical care plan) the number of long-term care beds and general beds has already reached the target number of long-term care beds and general beds for the relevant area as prescribed in a medical care plan that is in accordance with the requirements prescribed by the Order of the Ministry of Health, Labour and Welfare as set forth in paragraph (8) of the same Article, or if it is considered that establishing beds or increasing the number of beds as per the relevant application would exceed the relevant target.

③Where the number of long-term care beds and general beds in the area (an area provided for in Article 30-4, paragraph (2), item (xiv) as prescribed by a medical care plan) in which a hospital (limited to those with long-term care beds, etc.) or clinic (limited to those with beds permitted as set forth in paragraph (3) of the preceding Article) established by a person listed in any of the items of paragraph (1) has already reached the target number for long-term care beds and general beds in the relevant area as specified in a medical care plan that is in accordance with the requirements prescribed by the Order of the Ministry of Health, Labour and Welfare, as set forth in paragraph (8) of the same Article, when the relevant hospital or clinic is not engaging in all or some of the services related to long-term care beds, etc. under the permission set forth in paragraph (1) or paragraph (2) of the preceding Article or beds for which the permission set forth in paragraph (3) of the same Article has been received, without justifiable grounds, the prefectural governor may order the establisher or administrator of the relevant hospital or clinic to adopt measures to amend such permission so as to reduce the number of beds, up to and including the number of beds which are not used for the relevant services.

④In the cases set forth in the preceding three paragraphs, in calculating the number of existing beds in the relevant area and the number of beds to which the relevant application relates, the prefectural governor must carry out any necessary adjustments in consideration of the function and nature of the hospital or clinic, pursuant to the provisions of the Prefectural Ordinance in accordance with the requirements prescribed by the Order of the Ministry of Health, Labour and Welfare set forth in Article 30-4, paragraph (8).

⑤The prefectural governor must hear the opinions of the Prefectural Council on Medical Service Facilities in advance, when the governor wishes to refuse permission as set forth in paragraph (1) through paragraph (3) of the preceding Article pursuant to the provisions of paragraph (1) or paragraph (2) or if the governor wishes to issue an order pursuant to the provisions of paragraph (3).

⑥When a prefectural governor has issued an order as prescribed in paragraph (3) and the establisher or administrator of the hospital or clinic that has received the relevant order fails to comply with it, the prefectural governor may make a public announcement to that effect.

⑦When an incorporated administrative agency (an incorporated administrative agency as provided for in Article 2, paragraph (1) of the Act on General Rules for Incorporated Administrative Agencies (Act No. 103 of 1999)) that has been specified by a Cabinet Order, or the Japan Institute for Health Security, wishes to establish a hospital, increase bed numbers, or alter bed classifications at a hospital it has established, or where it wishes to establish beds in a clinic or increase bed numbers or alter bed classifications at a clinic, it must consult (or give notice where specially prescribed by Cabinet Order) with the Minister of Health, Labour and Welfare in advance regarding such plans. The same applies when it wishes to amend such plans.

①Where a prefectural governor has received an application for permission to establish a hospital or permission to increase the number of beds in a hospital (limited to those related to long-term care beds, etc.), if the governor finds that the total number of long-term care beds and general beds in the vision area including the location of the hospital pertaining to the relevant application has already reached the total number of beds required in the future prescribed in Article 30-4, paragraph (2), item (vii),(a) in the relevant vision area as specified in the medical care plan, or will exceed the total number of beds required due to the establishment of the hospital or the increase in the number of beds in the hospital pertaining to the relevant application, the governor may request the person who has filed the relevant application (hereinafter referred to as the "applicant" in this Article) to submit a document stating the reason why it is necessary to establish a hospital or increase the number of beds in the hospital in the relevant vision area and other particulars specified by an Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as the "reasons, etc." in this Article).

②When the prefectural governor finds that the reasons, etc. are not sufficient, the governor may request the applicant to participate in the consultation at the place of consultation prescribed in Article 30-14, paragraph (1).

③The applicant, when requested by the prefectural governor pursuant to the provisions of the preceding paragraph, must endeavor to respond to the request.

④The prefectural governor, when an agreement is not reached through the consultation at the place of consultation set forth in paragraph (2) or when otherwise specified by an Order of the Ministry of Health, Labour and Welfare, may request the applicant to attend a meeting of the Prefectural Council on Medical Service Facilities and explain the reasons, etc.

⑤The applicant, when requested by the prefectural governor pursuant to the provisions of the preceding paragraph, must endeavor to attend the meeting of the Prefectural Council on Medical Service Facilities and explain the reasons, etc.

⑥Notwithstanding the provisions of Article 7, paragraph (4), the prefectural governor, if the reasons, etc. are not found to be unavoidable based on the content of the consultation at the place of consultation set forth in paragraph (2) and the content of the explanation set forth in paragraph (4), may decide not to grant the permission set forth in paragraph (1) or (2) of the same Article to the applicant (limited to those listed in the items of paragraph (1) of the preceding Article).

⑦When the prefectural governor decides not to grant the permission set forth in paragraph (1) or (2) of Article 7 under the provisions of the preceding paragraph, the governor must hear the opinions of the Prefectural Council on Medical Service Facilities in advance.

⑧The provisions of the preceding paragraphs apply mutatis mutandis to an application for permission to set up new beds in a clinic or permission to increase the number of beds in a clinic. In this case, the term "paragraph (1) or (2) of the same Article" in paragraph (6) is to be replaced with "paragraph (3) of the same Article", and the term "paragraph (1) or (2) of Article 7" in the preceding paragraph is to be replaced with "paragraph (3) of Article 7".

①When a clinically trained physician, a clinically trained dentist, or a midwife establishes a clinic or birthing center, the physician must notify the prefectural governor of the area in which the clinic or birthing center is situated within ten days of its establishment.

②The founder of a facility for receiving online medical care must notify the prefectural governor of the area in which the facility is situated (or, where its location is within the area of a city with a public health center or a special ward of Tokyo, the mayor of the city with a public health center or the mayor of the special ward) within ten days of its establishment.

①The establisher of a hospital, clinic or birthing center, or the founder of a facility for receiving online medical care, must not suspend the operation of the relevant hospital, clinic, birthing center or facility for receiving online medical care for more than one year without justifiable grounds; provided, however, that this does not apply to the establisher of a clinic or birthing center of which the prefectural governor was notified and that was established pursuant to the provisions of paragraph (1) of the preceding Article.

②When the establisher of a hospital, clinic or birthing center, or the founder of a facility for receiving online medical care, suspends the operation of the relevant hospital, clinic, birthing center or facility for receiving online medical care, they must notify the prefectural governor (in the case of a clinic, birthing center or facility for receiving online medical care, where its location is within the area of a city with a public health center or a special ward of Tokyo, the mayor of the city with a public health center or the mayor of the special ward; the same applies in the following Article, Article 24-2, Article 29, paragraph (1), Article 29-2 and Article 30) within ten days. The same applies when they resume the operation of a suspended hospital, clinic, birthing center or facility for receiving online medical care.

①When the establisher of a hospital, clinic or birthing center, or the founder of a facility for receiving online medical care, discontinues the operation of the relevant hospital, clinic, birthing center or facility for receiving online medical care, they must notify the prefectural governor within ten days.

②When the establisher of a hospital, clinic or birthing center, or the founder of a facility for receiving online medical care, has died or has become the subject of an adjudication of disappearance, the person who is obligated to submit a notification of such person's death or disappearance pursuant to the provisions of the Family Register Act (Act No. 224 of 1947) must notify the prefectural governor of the area in which the relevant hospital, clinic, birthing center or facility for receiving online medical care is situated of the same within ten days.

①The establisher of a hospital (excluding hospitals specified by an Order of the Ministry of Health, Labour and Welfare set forth in paragraph (3); the same applies in the following paragraph) or clinic is to have it managed by a clinically trained physician where a medical practice is operated at the relevant hospital or clinic, or must have it managed by a clinically trained dentist where a dental practice is operated at the relevant hospital or clinic.

②Where both a medical practice and dental practice are operated at a hospital or clinic, the establisher of the relevant hospital or clinic is to have it managed by a clinically trained physician where it is primarily for the operation of a medical practice, or must have it managed by a clinically trained dentist where it is primarily for the operation of a dental practice.

③The establisher of a hospital that provides necessary support for securing medical care in an acute physician shortage area or other hospitals specified by an Order of the Ministry of Health, Labour and Welfare, in the case that the hospital is engaged in medical practice or in the case that the hospital is engaged in both medical practice and dental practice and mainly engages in medical practice, may have it managed by a clinically trained physician certified under Article 5-2, paragraph (1); provided, however, that in the case that affects the provision of medical care in the region or in other cases specified by an Order of the Ministry of Health, Labour and Welfare, the hospital may be managed by a clinically trained physician who has not been certified under Article 5-2, paragraph (1).