Florida

Board

of

Podiatric Medicine

If a “yes” response is provided to any of the health history questions on the application, the applicant is required to submit supporting documentation including the relevant dates and circumstances and the names and addresses of the medical practitioners or hospitals who performed related treatments. The application is considered incomplete until all supporting documentation is provided to the department.

Applicants with prior disciplinary actions on any license from any state are required to submit the following supplemental documentation:

Board Actions – Certified copies of documents relative to any disciplinary action taken against any license. The documents must be certified and submitted by the agency or board that finalized the disciplinary action.

Self-Explanation – Applicants who have listed license discipline on the application must submit a letter to the board personally describing the circumstances that led to the disciplinary action. The letter should also include a thorough description of the rehabilitation taken by the applicant since the time of the event which would facilitate prevention of future occurrences.

Applicants who have been convicted of a misdemeanor or felony; or entered a plea of guilty, nolo contendere, or no contest to any crime in any jurisdiction; even if adjudication was withheld by the court; must answer the criminal history questions on the application and provide the following supplemental documentation:

Final Dispositions/Arrest Records – Final disposition records for offenses can be obtained at the clerk of the court in the arresting jurisdiction. If the records are not available, a letter on court letterhead must be sent from the clerk of the court attesting to records unavailability.

Completion of Sanctions – Probation and financial sanction records for offenses can be obtained at the clerk of the court in the arresting jurisdiction. Parole records for offenses can be obtained from the Department of Corrections or at the clerk of the court in the arresting jurisdiction. If the records are not available, a letter on court letterhead must be sent from the clerk of the court attesting to records unavailability.

Self-Explanation – Applicants who have listed offenses on the application must submit a letter personally describing the circumstances of the offense. The letter must include the date of the original offense, the charge, and the jurisdiction where the incident occurred.

The applicant must complete a criminal background screening pursuant to section 456.0135, Florida Statutes, by submitting fingerprints electronically through a service provider approved by the Florida Department of Law Enforcement. The results will be returned to the Care Provider Background Screening Clearinghouse and are made available to the Department for review during the licensure process. Applicant fingerprints will be retained by FDLE and the Clearinghouse. All costs for conducting criminal history background screening and the retention of fingerprints are the responsibility of the applicant.

It is important to use the correct Originating Agency Identification (ORI) when submitting fingerprints. If an incorrect ORI number is provided to the Livescan service provider, the Department will not receive the results.

The ORI number for the Board of Podiatric Medicine is EDOH2017Z.

The applicant is responsible for selecting an approved Livescan Service Provider and for ensuring the results are reported to the Department. Print the electronic fingerprinting form, complete the information, and take the form to a Livescan Service Provider. Upon completion of electronic fingerprinting, document the Transaction Control Number. This number is useful to track the fingerprint records in the event they are not properly transmitted to the Department.

For more information, frequently asked questions, and a list of all approved Livescan Service Providers, visit the Background Screening website at: https://www.flhealthsource.gov/background-screening.

Effective July 1, 2012, Section 456.0635, Florida Statutes (F.S.), provides that health care boards or the department shall refuse to issue a license, certificate or registration and shall refuse to admit a candidate for examination if the applicant:

1. Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under Chapter 409, F.S., (relating to social and economic assistance), Chapter 817, F.S., (relating to fraudulent practices), Chapter 893, F.S., (relating to drug abuse prevention and control) or a similar felony offense(s) in another state or jurisdiction unless the candidate or applicant has successfully completed a drug court program for that felony and provides proof that the plea has been withdrawn or the charges have been dismissed. Any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration, unless the sentence and any subsequent period of probation for such conviction or plea ended:
   1. For the felonies of the first or second degree, more than 15 years from the date of the plea, sentence and completion of any subsequent probation;
   2. For the felonies of the third degree, more than 10 years from the date of the plea, sentence and completion of any subsequent probation;
   3. For the felonies of the third degree under section 893.13(6)(a), F.S., more than five years from the date of the plea, sentence and completion of any subsequent probation;
2. Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under 21 U.S.C. ss. 801-970 (relating to controlled substances) or 42 U.S.C. ss. 1395-1396 (relating to public health, welfare, Medicare and Medicaid issues), unless the sentence and any subsequent period of probation for such conviction or pleas ended more than 15 years prior to the date of the application;
3. Has been terminated for cause from the Florida Medicaid program pursuant to section 409.913, F.S., unless the candidate or applicant has been in good standing with the Florida Medicaid program for the most recent five years;
4. Has been terminated for cause, pursuant to the appeals procedures established by the state or Federal Government, from any other state Medicaid program, unless the candidate or applicant has been in good standing with a state Medicaid program for the most recent five years and the termination occurred at least 20 years before the date of the application;
5. Is currently listed on the United States Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities.