Get Arnp Florida Protocol Form

Get Arnp Florida Protocol Form

The ARNP Florida Protocol form is a vital document that establishes a formal relationship between a physician and an Advanced Registered Nurse Practitioner (ARNP), Emergency Medical Technician (EMT), or Paramedic. This form ensures that medical acts performed by these professionals are recognized and approved, facilitating seamless collaboration in patient care. To maintain compliance, it is crucial to fill out this form accurately and submit it within the specified timeframes.

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Structure

The ARNP Florida Protocol form is a vital document that facilitates collaboration between physicians and Advanced Registered Nurse Practitioners (ARNPs), Emergency Medical Technicians (EMTs), and Paramedics. This form ensures that medical acts performed by these healthcare professionals are conducted under an established protocol approved by the appropriate regulatory bodies. According to Florida Statutes, specifically S. 458.348(1)(a), when a physician enters into a protocol with an ARNP, EMT, or Paramedic, they are required to notify the Board of Medicine. This notification must include essential details such as the physician's name, license number, and practice location, along with the names and license numbers of the ARNPs, EMTs, or Paramedics involved. The completed form must be submitted within thirty days of establishing the protocol or terminating any existing supervisory relationships. Additionally, it is crucial to file the protocol form within thirty days of the ARNP's license renewal or any changes to the protocol itself. Importantly, only one physician can be listed per form, and additional sheets are available for listing multiple ARNPs, EMTs, or Paramedics. This structured approach not only reinforces accountability but also enhances the quality of care provided to patients across Florida.

Arnp Florida Protocol Preview

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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

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Document Data

Fact Name Fact Description
Governing Law The protocol form is governed by Florida Statutes, specifically s. 458.348(1)(a) and s. 464.003(3)(c).
Purpose of the Form This form is used when a physician establishes a protocol with an Advanced Registered Nurse Practitioner (ARNP), Emergency Medical Technician (EMT), or Paramedic.
Notice Requirement The physician must submit notice to the Board of Medicine when entering into or terminating a protocol.
Timeframe for Submission Notice must be filed within 30 days of entering into or terminating the protocol.
Information Required The notice must include the physician's name, license number, practice location, and the names and license numbers of the ARNP, EMT, or Paramedic involved.
Signature Requirement The form must be signed by the physician to be considered valid.
Submission Method The completed form can be mailed or faxed to the Department of Health, Board of Medicine.
Renewal Requirement The protocol form must be filed within 30 days of the ARNP’s license renewal or any changes to the protocol.
Limitations Only one physician can be listed per protocol form; additional sheets are needed for more ARNPs, EMTs, or Paramedics.
Form Version The current version of the form is DH-MQA1069, with the last revision in June 2013.

How to Use Arnp Florida Protocol

Filling out the ARNP Florida Protocol form is a straightforward process. Once completed, you will need to submit it to the appropriate department within the specified timeframe. Below are the steps to guide you through filling out the form correctly.

  1. Begin by entering the physician's name in the designated space. Ensure that you type or print clearly.
  2. Next, input the physician's license number. This is usually found on the physician's official documentation.
  3. Provide the practice location of the physician. Again, type or print this information clearly.
  4. Identify the ARNP, EMT, or Paramedic with whom the physician is entering into the protocol. Print or type their name in the appropriate section.
  5. Fill in the license number of the ARNP, EMT, or Paramedic.
  6. Specify the effective date of the protocol. This should reflect when the protocol will begin.
  7. The physician must sign the form to validate the protocol. Ensure the signature is clear and legible.
  8. Once completed, return the form to the Department of Health, Board of Medicine, at the address provided. Alternatively, you can fax it to the specified number.

Remember to submit the form within 30 days of entering into the protocol or any changes to it. If there are multiple ARNPs, EMTs, or Paramedics involved, use additional sheets as needed. Following these steps will help ensure compliance with the regulations.

Key Facts about Arnp Florida Protocol

What is the ARNP Florida Protocol form?

The ARNP Florida Protocol form is a document that must be completed by physicians who enter into a formal protocol relationship with Advanced Registered Nurse Practitioners (ARNPs), Emergency Medical Technicians (EMTs), or Paramedics. This form serves to notify the Florida Board of Medicine about the established protocols that allow these healthcare professionals to perform specific medical acts as approved by the board.

Who needs to complete the ARNP Florida Protocol form?

The form must be completed by physicians who establish a protocol with an ARNP, EMT, or Paramedic. It is essential for ensuring that the physician's supervisory relationship is officially recognized and documented with the state medical board.

What information is required on the form?

The form requires several key pieces of information. This includes the physician's name, license number, practice location, and the names and license numbers of the ARNPs, EMTs, or Paramedics involved. Additionally, the effective date of the protocol must be provided, along with the physician's signature to validate the submission.

How long do I have to submit the ARNP Florida Protocol form?

The protocol form must be submitted to the Florida Board of Medicine within 30 days of entering into the protocol relationship. This timeline is crucial to ensure compliance with Florida Statutes. If the physician terminates the relationship, a notice must also be submitted within 30 days of that termination.

Is additional documentation required when submitting the form?

No additional documentation is required when submitting the ARNP Florida Protocol form. The form itself contains all necessary information to notify the board about the established protocol. However, it is important to ensure that all fields are accurately completed to avoid delays in processing.

What should I do if there are multiple ARNPs, EMTs, or Paramedics?

If there are multiple ARNPs, EMTs, or Paramedics involved in the protocol, the physician should use extra sheets to provide their names and license numbers. Only one physician's information should be included per form, ensuring clarity and compliance with the submission requirements.

Where do I send the completed ARNP Florida Protocol form?

The completed form should be returned to the Department of Health, Board of Medicine, at 4052 Bald Cypress Way, BIN #C-03, Tallahassee, FL 32399-3253. Alternatively, it can be faxed to 850-488-0596. Ensuring that the form is sent to the correct address is vital for proper processing.

What happens if I do not submit the form on time?

Failure to submit the ARNP Florida Protocol form within the required 30-day period may lead to compliance issues with the Florida Board of Medicine. This could result in penalties or complications in maintaining the protocol relationship. It is important to adhere to the timelines to ensure that all parties involved remain in good standing.

Common mistakes

Filling out the ARNP Florida Protocol form can seem straightforward, but many individuals make common mistakes that can lead to delays or complications. One frequent error is failing to include the correct physician license number. Each physician must provide their specific license number, and omitting this detail can result in the form being rejected. Always double-check that this number is accurate and complete.

Another mistake often made is neglecting to specify the practice location clearly. The form requires the practice location to be typed or printed legibly. Vague or incomplete addresses can cause confusion and may delay the processing of the protocol. Ensure that the address is detailed, including street name, city, and zip code.

People sometimes forget to sign the form. A signature is essential, as it verifies that the physician has entered into the protocol agreement. Without a signature, the submission is incomplete and cannot be processed. Remember to sign and date the form before submitting it.

Additionally, many individuals do not submit the form within the required timeframe. According to Florida statutes, the protocol form must be filed within thirty days of establishing or terminating the relationship. Missing this deadline can lead to penalties or complications in practice, so it's crucial to be aware of these timelines.

Another common oversight is using the form for multiple physicians. The guidelines specify that only one physician can be listed per form. If there are additional ARNPs, EMTs, or Paramedics, it’s necessary to use extra sheets. Failing to follow this instruction can result in processing delays.

Lastly, some individuals may overlook the requirement for no additional documentation. While it may seem minor, ensuring that you only submit the form without extra documents is important. Including unnecessary paperwork can complicate the review process and lead to confusion. Keeping the submission simple and to the point will help facilitate a smoother experience.

Documents used along the form

When working with the ARNP Florida Protocol form, several other forms and documents are often necessary to ensure compliance with state regulations. These documents help clarify the relationship between healthcare providers and outline specific responsibilities. Below is a list of commonly used forms that accompany the ARNP Florida Protocol form.

  • Physician Collaboration Agreement: This document outlines the working relationship between the physician and the ARNP. It details the scope of practice and the responsibilities of each party.
  • Continuing Education Documentation: ARNPs must maintain their licensure through ongoing education. This documentation proves that the ARNP has completed the required courses and training.
  • Patient Care Protocols: These are specific guidelines that dictate how patient care should be administered. They ensure that both the physician and ARNP are on the same page regarding treatment plans.
  • Emergency Contact Information: This form provides essential contact details for the physician and ARNP in case of emergencies or urgent consultations.
  • Supervision Agreement: If the ARNP is working under supervision, this document outlines the supervisory relationship and the extent of the physician's oversight.
  • Termination Notice: When a protocol or supervisory relationship ends, this notice must be submitted to inform the Board of Medicine of the change.

These documents are crucial for maintaining compliance and ensuring that patient care is delivered effectively. It is important to keep all forms updated and readily available to avoid any potential issues with regulatory authorities.

Similar forms

The ARNP Florida Protocol form shares similarities with several other important documents in the medical field. Each of these documents serves a specific purpose in ensuring proper communication and compliance within healthcare practices. Below are seven documents that are comparable to the ARNP Florida Protocol form:

  • Physician-Patient Agreement: This document outlines the terms of the relationship between a physician and a patient, similar to how the ARNP Protocol form establishes the relationship between a physician and an ARNP.
  • Delegation of Authority Form: This form allows a physician to delegate specific medical tasks to an ARNP or other healthcare provider, mirroring the delegation of responsibilities outlined in the ARNP Protocol.
  • Standing Orders: Standing orders provide pre-approved medical instructions that healthcare providers must follow, akin to the protocols established in the ARNP Florida Protocol form.
  • Collaboration Agreement: This document details the collaborative practice arrangements between a physician and an ARNP, similar to the established protocols in the ARNP form.
  • Scope of Practice Documentation: This outlines the specific medical acts that a healthcare provider is authorized to perform, just as the ARNP Protocol specifies approved medical acts.
  • Emergency Protocols: Emergency protocols provide guidelines for handling urgent medical situations, paralleling the structured approach of the ARNP Protocol form.
  • License Renewal Application: This application requires healthcare providers to confirm their compliance with state regulations, much like the requirement to file the ARNP Protocol within 30 days of license renewal.

Dos and Don'ts

When filling out the ARNP Florida Protocol form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do.

  • Do type or print the physician's name clearly.
  • Do include the correct license number for the physician.
  • Do submit the form within 30 days of entering into or terminating a protocol.
  • Do provide the practice location accurately.
  • Don't leave any required fields blank.
  • Don't submit multiple physicians on the same form; use extra sheets as needed.

Misconceptions

Misconceptions about the ARNP Florida Protocol form can lead to confusion among healthcare professionals. Here are four common misunderstandings:

  • Only physicians can use the protocol form. Many believe that only physicians are involved in the protocol process. In reality, Advanced Registered Nurse Practitioners (ARNPs), Emergency Medical Technicians (EMTs), and Paramedics also play crucial roles and must be included in the protocol agreements.
  • Submission of the form is optional. Some individuals think that submitting the protocol form is not mandatory. However, Florida law requires physicians to submit this form within 30 days of entering into or terminating a protocol relationship with an ARNP, EMT, or Paramedic.
  • Additional documentation is needed. There is a misconception that extra paperwork is necessary when submitting the protocol form. In fact, the form itself is sufficient, and no additional documentation is required when filing.
  • The protocol form is only needed once. Many assume that the protocol form only needs to be filed once. However, it must be submitted again within 30 days of the renewal of the ARNP’s license or any changes made to the protocol.

Key takeaways

Here are key takeaways about filling out and using the ARNP Florida Protocol form:

  1. Timely Submission: You must submit the protocol form to the Board of Medicine within 30 days of establishing or terminating a relationship with an ARNP, EMT, or Paramedic.
  2. Single Physician Rule: Only one physician can be listed per protocol form. If you have multiple ARNPs, EMTs, or Paramedics, use additional sheets for each.
  3. No Extra Documentation: When submitting the form, no additional documentation is required. Just complete the form accurately.
  4. License Renewal: Ensure the protocol form is filed within 30 days of the ARNP’s license renewal or any changes to the protocol.
  5. Correct Information: Fill in all required fields, including names, license numbers, and practice locations, to avoid delays in processing.
  6. Signature Required: The form must be signed by the physician entering into the protocol to validate the agreement.

Following these guidelines will help ensure compliance with Florida statutes and smooth operation in your practice.