Current Licensees

PRACTITIONER'S GUIDE TO COMPLETING AND UPDATING THE PROFILE (pdf - 21kb)

Frequently Requested Forms:

• Address Change Form (pdf - 42kb)
• Financial Responsibility (pdf - 43kb) (Updated 1/2007)
  S. 458.320(1)(b) Financial Responsibility, explains that your professional liability coverage must be with an authorized insurer. s.624.09, F.S. defines an “authorized” insurer is one duly authorized by a subsisting certificate of authority issued by the office to transact insurance in this state.
  The Department of Financial Services provides a web site listing only authorized insurers pursuant to s. 624.09. http://www.fldfs.com/data/companysearch/index.asp
  Before choosing an insurance carrier, review the web site to insure compliance with the Florida Statutes.
• What do I do if I elect not to carry medical malpractice insurance? (pdf - 12kb)
• Administrative Voluntary Relinquishment (pdf - 44kb) (Voluntary)
  64B8-8.018 Voluntary Relinquishment of License.
  (1) If a licensee wishes to voluntarily relinquish a license at a time when no investigation has been initiated against the licensee, no investigation against the licensee is anticipated, and no disciplinary action is pending, and the licensee is not under any current restrictions by the Board of this state or any other jurisdiction, then the licensee’s request for voluntary relinquishment may be acted upon by staff without further action by the Board. In such a case, the voluntary relinquishment shall not be considered action against the license as that term is used in Section 458.331(1)(b), F.S.
  Specific Authority 458.309, 120.53 FS. Law Implemented 458.331 FS. History-New 2-21-93, Formerly 21M-20.018, 61F6-20.018, 59R-8.018.
• Disciplinary Voluntary Relinquishment (pdf - 44kb)
  64B8-8.018 Voluntary Relinquishment of License.
  (2) If a licensee wishes to voluntarily relinquish a license, but the licensee or the license is currently under any of the constraints set forth in subsection (1) above, then the licensee may relinquish the license only with the approval of the Board. If the voluntary relinquishment is accepted by the Board at the time an investigation is underway, or is anticipated, or when a disciplinary action is in progress, then the acceptance of the voluntary relinquishment of the license shall be considered action against the license as that term is used in Section 458.331(1)(b), F.S., and shall be reported as such by the Board.
  Specific Authority 458.309, 120.53 FS. Law Implemented 458.331 FS. History-New 2-21-93, Formerly 21M-20.018, 61F6-20.018, 59R-8.018. NOTE: By signing this form in the disciplinary process, a licensee agrees that it constitutes disciplinary action and further agrees to never reapply for licensure in Florida again. The relinquished license cannot be reinstated. This information is also forwarded to national databanks and could be reported to other states where the licensee is also licensed. Other states may require the licensee to report disciplinary action to them within a specified period of time. The licensee should contact those states for further information regarding their reporting requirements.
• Dispensing Practitioner Registration (pdf - 45kb)
• Dispensing Practitioner Add-Delete Locations Form (pdf - 45kb)
• List of Approved Critical Need Facilities (pdf - 132kb)
• Physician Office Adverse Incident Report (pdf - 76kb)
• Advanced Registered Nurse Practitioner Protocol (pdf - 23kb)

Physician Protocol Requirements

• Pursuant to Section 458.348(1)(a), Florida Statutes, when a physician enters or terminates an established supervisory relationship with an advanced registered nurse practitioner, an emergency medical technician or a paramedic, the physician must submit a notice to the board.
• Download the required Protocol form. (pdf - 23kb)
• For further information concerning ARNPS protocols, see the Board of Medicine Rule 64B8-35, F.A.C. and visit the Board of Nursing website for further information.

Physician Assistant Supervision Data Form - Supervision Requirements from Physicians:

• When a physician enters or terminates an established supervisory relationship with a physician assistant, the physician must submit a notice to the board.
• Download the required Supervision Data Form (pdf - 62kb) and for further information, visit the Council on Physician Assistant website for further information.

Continuing Education

Obtain a Written License Certification

How Do I . . . Change My Name, Request a Duplicate License, Change One of My Addresses?

Telecommunications Relay System Information (pdf - 50kb)