Board Of Osteopathic Medicine Arnp / Emt / Paramedic Protocol Form printable pdf download

Board Of Osteopathic Medicine Arnp / Emt / Paramedic Protocol Form

Rick Scott

Mission

Governor

To protect, promote & improve the health

of all people in Florida through integrated

Celeste Philip, MD, MPH

state, county & community efforts.

State Surgeon General

Vision: To be the Healthiest State in the Nation

Board of Osteopathic 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.

,________________________________

OS____________________

(Please type or print name of physician)

License number

have hereby ___entered or ____ terminated a formal supervisory

relationship, standing orders, or an established protocol

_____________(number of persons) emergency medical technician(s),

_____________(number of persons) paramedic(s), or

____________(number of persons) advanced registered nurse practitioner(s).

____________________________________________________

(Signature of Physician)

Complete this form and return it to: Department of Health, Board of Osteopathic Medicine,

4052 Bald Cypress Way, BIN#C-06, Tallahassee, FL 32399-3253, or fax it to 850-921-6184.

No additional documentation required.

(b) Notice shall be filed within 30 days after

entering into the relationship, orders, or protocol. Notice also shall be provided within 30 days

after the osteopathic physician has terminated any such relationship, orders, or protocol.

Florida Department of Health

Division of Medical Quality Assurance

Bureau of Health Care Practitioner Regulation / Board of Osteopathic

Medicine

4052 Bald Cypress Way, Bin C-06 • Tallahassee, FL 32399

PHONE: 850/245-4161 • FAX: 850/921-6184

FloridaHealth.gov

Board Of Osteopathic Medicine Arnp / Emt / Paramedic Protocol Form