64B8-4.009. Applications

(1) All persons applying for licensure shall submit an application to the Department. The application shall be made on the applicable form set forth below, all of which are hereby adopted and incorporated by reference and can be obtained from the website at http://www.flhealthsource.gov/mqa-services. The application must be accompanied by the application fee.

(a) DH-MQA 1000, entitled “Medical Doctor Application for Licensure,” (12/20), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-12830, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;

(b) DH-MQA 1008, entitled “Medical Doctor Application for Limited Licensure,” (12/20), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-12831, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;

(c) DH-MQA 1009, entitled “Temporary Certificate for Medical Doctors to Practice in an Area of Critical Need,” (02/21), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-13217, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;

(d) DH-MQA 1032, entitled “Application for Intern/Resident/Fellow or House Physician Initial or Renewal Registration,” (12/20), http://www.flrules.org/Gateway/reference.asp?No=Ref-12834;

(e) DH-MQA 1072, entitled “Application for Medical Faculty Certificate for Allopathic Physicians,” (Rev. 6/2024), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-16987, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;

(f) DH-MQA 1079, entitled “Temporary Certificate for Visiting Physicians to Obtain Medical Privileges for Instruction Purposes in Conjunction with Certain Plastic Surgery, Medical or Surgical Training Programs and Educational Symposiums,” (10/2022), http://www.flrules.org/Gateway/reference.asp?No=Ref-14982.

(g) DH-MQA 5001, entitled “Rear Admiral LeRoy Collins, Jr., Medical Doctor Application for Temporary Certificate to Practice in an Area of Crital Need for Active Duty Military and Veterans,” (02/21), http://www.flrules.org/Gateway/reference.asp?No=Ref-13218.

(h) DH-MQA 5055, entitled “Application for Public Health Certificate,” (12/20), http://www.flrules.org/Gateway/reference.asp?No=Ref-12838.

(i) DH-MQA 5056, entitled “Application for Public Psychiatry Certificate,” (12/20), http://www.flrules.org/Gateway/reference.asp?No=Ref-12839.

(j) DH-MQA 5058, entitled “Temporary Certificate for Visiting Physicians in Cancer Centers,” (10/2022), http://www.flrules.org/Gateway/reference.asp?No=Ref-14983.

(k) DH-MQA 5089, entitled “Application for Graduate Assistant Physician Initial or Renewal Limited License,” (6/2024), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-17146, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html.

(2) An official verification of the applicant’s medical education from the medical school which comes directly from the medical school to the Board office, unless the applicant has had his or her medical credentials evaluated by the Educational Commission for Foreign Medical Graduates (ECFMG) and holds an active, valid certificate issued by the ECFMG.

(3) An applicant must submit examination score reports which come directly from the testing entity to the Board office.

Rulemaking Authority 456.013, 456.025, 456.031, 456.033, 458.309, 458.311, 458.313, 458.3145, 458.3151, 458.345 FS. Law Implemented 456.013(1), (2), (13), 456.0135, 456.025, 456.031, 456.033, 456.039, 456.049, 456.50, 456.0635, 458.311, 458.3124, 458.313, 458.3137, 458.3145, 458.315, 458.3151, 458.316, 458.3165, 458.317, 458.320, 458.345, 766.314 FS. History–New 3-31-80, Amended 12-4-85, Formerly 21M-22.09, Amended 9-7-88, 3-13-89, 1-1-92, 2-21-93, Formerly 21M-22.009, Amended 11-4-93, Formerly 61F6-22.009, Amended 11-15-94, 2-15-96, Formerly 59R-4.009, Amended 7-10-01, 1-31-02, 5-10-04, 5-20-04, 6-13-06, 12-26-06, 1-18-09, 3-17-09, 10-7-09, 1-7-10, 5-18-10, 2-28-12, 1-27-13, 8-5-13, 11-10-13, 1-9-14, 7-15-14, 9-10-14, 12-2-14, 3-17-15, 5-19-15, 9-28-15, 11-11-15, 8-14-16, 9-26-16, 2-6-17, 11-6-17, 2-26-18, 3-3-19, 9-23-20, 4-11-21, 7-13-21, 1-23-23, 10-3-24, 11-14-24.