Arnp Florida Protocol Form in PDF
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The Advanced Registered Nurse Practitioner (ARNP) Florida Protocol form serves as a crucial document that facilitates collaboration between physicians and ARNPs, Emergency Medical Technicians (EMTs), and Paramedics. This form is mandated by Florida Statutes, specifically section 458.348, which outlines the responsibilities of physicians in establishing protocols for medical acts. By submitting this form, physicians formally notify the Board of Medicine about their established protocols, ensuring compliance with state regulations. The form requires specific information, including the physician's name, license number, and practice location, as well as the names and license numbers of the ARNPs, EMTs, or Paramedics involved. Importantly, it must be submitted within thirty days of entering into or terminating any supervisory relationship or protocol. This timely submission is essential for maintaining the integrity of medical practices and ensuring that healthcare providers operate within the legal framework. Additionally, the form must be filed whenever there is a renewal of the ARNP's license or any changes to the existing protocol. The process is straightforward, requiring no additional documentation beyond the completed form. Compliance with these requirements not only fosters a collaborative healthcare environment but also protects the interests of both practitioners and patients in Florida.
Form 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
NOTE: Only one physician per form. Use extra sheets for additional ARNP’s / EMT’s / Paramedics.
Document Breakdown
| Fact Name | Description |
|---|---|
| Governing Law | The ARNP Florida Protocol form is governed by Section 458.348(1)(a) and (1)(b) of the Florida Statutes. |
| Submission Requirement | Physicians must submit a notice to the Board of Medicine when entering into a protocol with an ARNP, EMT, or Paramedic. |
| Time Frame for Submission | Notice must be filed within 30 days of establishing or terminating the relationship or protocol. |
| Single Physician Rule | Only one physician can be listed per ARNP Florida Protocol form. Additional practitioners require extra sheets. |
| Effective Date | The effective date of the protocol must be indicated on the form for both the physician and the ARNP, EMT, or Paramedic. |
| Submission Address | The completed form should be sent to the Department of Health, Board of Medicine, in Tallahassee, Florida. |
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