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Free Arnp Florida Protocol Form

The ARNP Florida Protocol Form is a crucial document that facilitates collaboration between physicians and Advanced Registered Nurse Practitioners (ARNPs), Emergency Medical Technicians (EMTs), and Paramedics in Florida. This form outlines the established protocols for medical acts that these professionals are authorized to perform, ensuring compliance with state regulations. By submitting this form, physicians formally notify the Board of Medicine about their collaborative agreements, fostering a safe and effective healthcare environment.

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Content Overview

Understanding Arnp Florida Protocol

What is the purpose of the ARNP Florida Protocol form?
The ARNP Florida Protocol form is used to establish a formal relationship between a physician and an Advanced Registered Nurse Practitioner (ARNP), Emergency Medical Technician (EMT), or Paramedic. This form ensures that the medical acts performed by the ARNP, EMT, or Paramedic are approved and recognized by the Board of Medicine in Florida.
Who needs to fill out this form?
This form must be completed by the physician who is entering into a protocol with an ARNP, EMT, or Paramedic. It is essential for the physician to provide their name, license number, and practice location, as well as the details of the ARNP, EMT, or Paramedic involved.
How long does a physician have to submit the form?
The physician is required to submit the ARNP Florida Protocol form within thirty (30) days of entering into the established protocol. If the relationship is terminated, a notice must also be submitted within thirty (30) days of that termination.
What information is needed on the form?
The form requires the following information:
- Physician's name and license number
- Practice location
- Name and license number of the ARNP, EMT, or Paramedic
- The effective date of the protocol
- Signature of the physician
Are there any additional documents required when submitting the form?
No additional documentation is needed when submitting the ARNP Florida Protocol form. The completed form itself suffices for the Board of Medicine.
What happens if the physician changes the protocol?
If there are any changes to the protocol, the physician must file the form again within thirty (30) days of the change. This ensures that the Board of Medicine has the most current information regarding the protocol.
Can multiple ARNPs, EMTs, or Paramedics be included on one form?
No, only one physician can be listed per form. If there are multiple ARNPs, EMTs, or Paramedics, additional sheets should be used to provide their details.
Where should the completed form be sent?
The completed ARNP Florida Protocol form should be sent to the Department of Health, Board of Medicine, at the following address:

4052 Bald Cypress Way, BIN #C-03, Tallahassee, FL 32399-3253

Alternatively, it can be faxed to 850-488-0596.
What is the significance of the effective date on the form?
The effective date indicates when the protocol begins. This date is crucial for both the physician and the ARNP, EMT, or Paramedic, as it marks the start of their formal working relationship under the established protocol.

Common mistakes

Failing to provide the physician's name in the designated space. Ensure the name is clearly typed or printed.
Omitting the license number of the physician. This number is essential for proper identification.
Not including the practice location. This information must be complete and accurate.
Neglecting to specify the ARNP(s), EMT(s), or Paramedic(s) involved in the protocol. Each participant must be listed.
Failing to sign the form. The physician's signature is required for the protocol to be valid.
Submitting the form after the 30-day deadline. It must be filed within thirty days of establishing or terminating the protocol.
Using the same form for multiple physicians. Each physician must complete a separate form.
Not providing an effective date for the protocol. This date is crucial for tracking the timeline of the agreement.
Forgetting to include any necessary additional documentation. While the form states no extra documentation is required, ensure all relevant information is complete.

How to Use Arnp Florida Protocol

Filling out the ARNP Florida Protocol form requires careful attention to detail to ensure compliance with state regulations. The following steps outline the process for completing the form accurately.

Obtain the ARNP Florida Protocol form from the Department of Health or relevant website.
In the first blank, type or print the name of the physician entering into the protocol.
Fill in the physician's license number in the designated space.
Provide the practice location by typing or printing the address in the appropriate field.
Indicate the name of the ARNP, EMT, or Paramedic involved in the protocol in the next blank.
Type or print the license number of the ARNP, EMT, or Paramedic in the following space.
Fill in the effective date of the protocol.
Have the physician sign the form in the signature section.
Review the completed form for accuracy and completeness.
Submit the form to the Department of Health, Board of Medicine, either by mail or fax.

After submitting the form, it is essential to keep track of any changes to the protocol or the status of the ARNP’s license. Remember, the protocol must be filed within thirty days of any renewal or change.

File Specs

Fact Name	Fact Detail
Governing Law	Section 458.348(1)(a) and (1)(b) of the Florida Statutes govern the ARNP Protocol Form.
Purpose	The form is used to establish a protocol between a physician and an ARNP, EMT, or Paramedic.
Notice Requirement	Physicians must submit notice to the Board of Medicine when entering into or terminating a protocol.
Filing Timeline	The notice must be filed within 30 days of entering or terminating the relationship.
Signature Requirement	The form must be signed by the physician and the ARNP, EMT, or Paramedic involved.
License Information	Both the physician and the ARNP/EMT/Paramedic must provide their license numbers on the form.
Submission Method	The completed form can be mailed or faxed to the Department of Health, Board of Medicine.
Additional Documentation	No additional documentation is required when submitting the protocol form.

↓ Arnp Florida Protocol PDF Form

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