Arnp Florida Protocol Form PDF Details

Do you own a business in the state of Florida? If so, you will want to be aware of a new protocol form that is now required by the state. The Arnp Florida Protocol Form must be completed and submitted for all businesses with one or more employees. This new form replaces all previous forms and is intended to streamline the process for both the state and businesses alike. Be sure to familiarize yourself with the requirements of this form and submit it as soon as possible. Missing the deadline could result in fines and other penalties.

QuestionAnswer
Form NameArnp Florida Protocol Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesboard medicine protocol, florida protocol form, board medicine arnp, florida protocol

Form Preview Example

.

Board of Medicine

ARNP / EMT / Paramedic Protocol Form

S. 458.348(1)(a), Florida Statutes, states in part, when a physician enters into an established protocol with an Advanced Registered Nurse Practitioner, an Emergency Medical Tech (EMT) or a Paramedic which protocol contemplates the performance of medical acts identified and approved by the joint committee pursuant to s. 464.003(3)(c) or acts set forth in s. 464.012(3) and (4), the physician shall submit notice to the board. The notice shall contain a statement in substantially the following form.

I,__,

(Please type or print name of physician)

license number ME00_______________of

__________________________________________________________________

(Please type or print practice location)

have hereby entered into a established protocol with

be filed within 30

(amount of)

terminated my formal supervisor relationship, standing orders, or an _ARNP(s), EMT(s), Paramedic(s). S. 458.348(1)(b), F.S. Notice shall

days of entering into the relationship, orders, or protocol. Notice also shall be provided within 30 days after the physician has terminated any such relationship, orders, or protocol.

 

__________

(Print or Type Name of ARNP/EMT/Paramedic)

 

(Print or Type Name of ARNP/EMT/Paramedic)

___________________________

___________________________

(License Number)

(License Number)

 

___________________________

(Effective Date)

(Effective Date)

__________________________________________________________________

(Signature of Physician)

Complete this form and return it to: Department of Health, Board of Medicine, 4052 Bald Cypress Way, BIN #C-03, Tallahassee, FL 32399-3253, or fax it to 850-488-0596. No additional documentation required. The protocol form must be filed with the Department within thirty (30) days of renewal of the ARNP’s license and any change to the protocol.

NOTE: Only one physician per form. Use extra sheets for additional ARNP’s / EMT’s / Paramedics.

DH-MQA1069 Rule 64B8-35.002 03/2003 Revised 6/2013

How to Edit Arnp Florida Protocol Form Online for Free

Handling PDF forms online is actually very simple with our PDF tool. You can fill in florida protocol form here painlessly. FormsPal team is focused on providing you with the absolute best experience with our tool by constantly presenting new features and improvements. With these improvements, working with our editor becomes better than ever before! All it takes is a few basic steps:

Step 1: Hit the orange "Get Form" button above. It will open up our pdf tool so that you can start filling in your form.

Step 2: With our state-of-the-art PDF editor, you're able to do more than simply complete blank form fields. Try all of the features and make your documents seem great with customized textual content added in, or tweak the file's original content to perfection - all that comes along with an ability to insert your personal images and sign the PDF off.

This document requires specific information to be entered, hence you should definitely take the time to fill in precisely what is required:

1. When filling in the florida protocol form, be sure to complete all important fields in its corresponding part. This will help facilitate the work, allowing your details to be processed quickly and appropriately.

Step number 1 of filling in board medicine protocol

2. Once this part is complete, you're ready to insert the required details in license number MEof have hereby, Effective Date, and Complete this form and return it in order to progress further.

Guidelines on how to fill in board medicine protocol step 2

Regarding license number MEof have hereby and Complete this form and return it, ensure that you don't make any mistakes here. Both of these are thought to be the most significant ones in this file.

Step 3: Before moving on, you should make sure that form fields are filled in right. Once you are satisfied with it, click on “Done." Get the florida protocol form after you subscribe to a 7-day free trial. Easily use the document within your FormsPal cabinet, with any modifications and adjustments automatically preserved! Whenever you work with FormsPal, you're able to fill out documents without being concerned about database leaks or data entries being shared. Our secure system helps to ensure that your personal data is kept safely.

Arnp Florida Protocol Form isn’t the one you’re looking for?

Related Documents