Florida Regulations 59A-30.003

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§ 59A-30.003 Procedure for Certification.

(1) To be certified as an expert medical advisor a physician shall:

(a) Meet the eligibility requirements as set out in Rule 59A-30.004, F.A.C.; and (b) Submit a signed, typed and completed application form AHCA Form 3160-0021 to the following address: Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop-26, Tallahassee, Florida 32308-5403. Illegible or unsigned applications shall be returned. The application form AHCA Form 3160-0021 is hereby incorporated by reference into Chapter 59A-30, F.A.C. The version of the form required by this rule shall bear the date January 20, 1995. A copy of the application form AHCA Form 3160-0021 may be obtained from the Agency at the address set forth in this paragraph. (c) Submit a current curriculum vitae, together with the application form AHCA Form 3160-0021, which shall include: 1. Type of practice (administration, medical teaching, medical research, group practice, consulting, retired, other); 2. Type of specialty including year of certification, recertification/subcertification as appropriate and name of certifying board; 3. Year of birth; 4. Date of medical degree and name of university conferring the degree; 5. Hospital affiliations; 6. Professional memberships; 7. Teaching positions; 8. Military record; 9. Name of articles and journals in which published. (d) Submit photocopy of current specialty board certificate or submit proof of specialty board eligibility. (e) Submit a copy of verification of Agency approved workers' compensation course completion.

(2) Within 30 days following verification of eligibility, the Agency shall notify the applicant of his/her status as an expert medical advisor.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History - New 1-23-95, Amended 6-8-95, Formerly 38F-54.003.