Florida

Board

of

Osteopathic Medicine

Physician Office Adverse Incident Report (pdf)

Osteopathic Physician Dispensing Application (pdf)

Cataract Operation Informed Consent (pdf)

Financial Responsibility Form (pdf)

Electronic Fingerprinting Form (pdf)

APRN/EMT/Paramedic Protocol Form (pdf)

Medical Marijuana Consent Form (pdf)

Statutorily Required Documentation

Information sent to Qualified Physicians – Feb 2019 (pdf)

Postgraduate Training Evaluation Form (pdf)

Statutorily Required Documentation-Smokable Medical Marijuana (pdf)

Electronic Prescribing Waiver (pdf)

Address Change Form (pdf)

Name Change Form (pdf)

Exhibit I Form (pdf)

Informed Consent Forms

Masculinizing Medications for Patients with Gender Dysphoria – Patient Information and Informed Consent Form (PDF)

Masculinizing Medications for Patients with Gender Dysphoria – Patient Information and Parental Consent and Assent for Minors (PDF)

Puberty Suppression Treatment for Patients with Gender Dysphoria – Patient Information and Parental Consent and Assent for Minors (PDF)

Surgical Treatment for Adults with Gender Dysphoria – Patient Information and Informed Consent (PDF)

Feminizing Medications for Patients with Gender Dysphoria – Patient Information and Informed Consent (PDF)

Feminizing Medications for Patients with Gender Dysphoria – Patient Information and Parental Consent and Assent for Minors (PDF)

Application for Full Licensure (pdf)

Mobile Opportunity by Interstate Licensure Endorsement (MOBILE) (pdf)

Initial & Renewal of Registration as Resident/Intern/Fellow
Osteopathic Physician in Training (pdf)

Application for Graduate Assistant Physician (pdf)

Limited Licensure Application (pdf)

Osteopathic Physician Dispensing Application (pdf)

Temporary Certificate for Practice in an Area of Critical Need Application (pdf)

Medical Faculty Certificate (pdf)

Reactivation Request (pdf)

Temporary Certificate for Active Duty Military and Veterans Practicing in Areas of
Critical Need (pdf)

Office Surgery Registration Application

Physician Office Adverse Incident Report

Pause/Time-Out Form

Surgical Logs

You may send the completed application, including documentation, by mail:

Department of Health
Board of Medicine
Post Office Box 6330
Tallahassee, Florida 32314-6330

If you need assistance, please contact the board office at 850-245-4131 or send an email to PMC_OSR@flhealth.gov.

Registration Application

Initial Licensure – Facility (Required)

Mandatory Insert for 456.0635 Questions – Facility

Data Reporting Form

Inspection Form

Application for Certificate of Exemption

SUBMITTING THE APPLICATION FOR EXEMPTION FROM PAIN MANAGEMENT CLINIC REGISTRATION

You may send the completed application, including documentation, by mail:

Department of Health
Board of Medicine
Post Office Box 6330
Tallahassee, Florida 32314-6330

If you need assistance, please contact the board office at 850-245-4131 or send an email to PMC_OSR@flhealth.gov.

American Medical Association
515 North State Street | Chicago, IL 60610
312.464.5000

American Osteopathic Association
142 East Ontario Street | Chicago, IL 60611
321.202.8000

Drug Enforcement Agency (DEA)
8400 Northwest 53rd Street | Miami, FL 33166
305.590.4870

Federation of State Medical Boards
400 Fuller Wiser Road, Suite 300 | Euless, TX 76039
817.868.4072

Florida Hospital Association (FHA)

Florida Osteopathic Medical Association (FOMA)
2544 Blairstone Pines Drive| Tallahassee, FL 32301
850.878.7364

National Board of Osteopathic Medical Examiners (NBOME)
2700 River Road, Suite 407 | Des Plaines, IL 60018
847.635.9955

National Practitioner’s Data Bank (NPDB)
Post Office Box 10832 | Chantilly, VA 22021
800.767.6732

Neurological Injury Compensation Association (NICA)
Post Office Box 14567 | Tallahassee, FL 32317-4567
850.488.8191

Click on Chapter or Rule to View

Florida Statutes

You will be connected to the Florida Legislature website, which is the official custodian of the statutes.

Chapter 120: Administrative Procedure Act
Chapter 456: Health Professions and Occupations: General Provisions
Chapter 459: Osteopathic Medicine

Florida Administrative Code (F.A.C.)

You will be connected to the Florida Department of State: State Library and Archives of Florida website, which is the official custodian of the administrative codes.

Rules: Chapter 64B15: Board of Osteopathic Medicine, Florida Administrative Code
Rules: Chapter 64B: Division of Medical Quality Assurance, Florida Administrative Code

Information on Nonopioid Alternatives for the Treatment of Pain

Professional Resource Network

Public Records

I Quit with AHEC

Practitioner Profile

Professional Resource Network

FLHealthSource

License Certification

Background Screening

Pain Clinic Registration

Medical Assistants (pdf)

Don’t Retire – Volunteer (pdf)

Reports and Publications

Livescan Service Providers

Physician Assistants

VeriDoc License Verification Service

Counterfeit-Proof Prescription Program

Health Care Clinic Establishment Permit

Public School Volunteer Practitioner Program

Declaratory Statements and Petitions for Variance or Waivers

Multistate Epidemiological Investigation Associated with Sterile Injections

New Reporting Requirements for Sexually Transmitted Diseases(pdf)

Radon Guide for Health Care Providers

Donation and Human Transfer of Human Tissue pamphlet

Office of Medical Marijuana Use Website

January 1, 2019 Physician Certification Pattern Review Panel Annual Report

January 1, 2020 Physician Certification Pattern Review Panel Annual Report

Know the Facts about Patients (pdf)

Know the Facts about Qualified Physicians (pdf)

Know the Facts about Legal Use (pdf)

Medical Marijuana Consent Form (pdf)

Statutorily required documentation (pdf)

Statutorily required documentation – Smokeable Medical Marijuana (pdf)

Physicians Assistant Workforce Survey Report
2022 – 2024 Physician Assistant Workforce Survey Report (pdf)

Physician Certification Pattern Review Panel Annual Report
January 1, 2019 Report
(pdf – 6.9mb)

January 1, 2020 Report
(pdf – 4kb)

January 1, 2021 Report
Physician Certification Pattern Review 2021 Annual Report
(pdf – 2mb)

Data Tables for Physician Certification Pattern Review 2021 Annual Report
(pdf – 3mb)

January 1, 2022 Report
Physician Certification Pattern Review 2022 Annual Report
(pdf – 1.7mb)

Data Tables for Physician Certification Pattern Review 2022 Annual Report
(pdf – 2.9mb)

January 1, 2024 Report
Physician Certification Pattern Review 2024 Annual Report
(pdf – 8.1mb)

Data Tables for Physician Certification Pattern Review 2024 Annual Report
(pdf – 9.2mb)

What the Practitioner Should Know about Certifying Cause of Death on the Florida Death Certificate (pdf)

Electronic Death Registration System EDRS Informational Brochure (pdf)

Computer Use and Confidentiality Agreement (pdf)

Citrix Remote Access Form (pdf)

Determination of Areas of Critical Need (pdf)