Last Updated 10/30/13 - Florida Department of Health...2013/10/30 · • the practitioner’s...

Last Updated 10/30/13

UNDERSTANDING PROFILING

In 1997, the Florida Legislature passed a law requiring the Department of Health to maintain profiles on certain health professionalslicensed in Florida. The law also specified the information to be maintained, how it was to be reported, and other requirements dealing with compiling and updating the information in the profiles.

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Which professions are required to have profiles?Practitioner profiles are required for all Medical Doctors(M.D.s), Osteopathic, Chiropractic and PodiatricPhysicians, and Advanced Registered Nurse Practitioners licensed in Florida.

What information is included in the profile?

The profile contains required and optional informationfrom the practitioner. Required information includes:

• the practitioner’s education and training

• the practitioner’s current practice and mailing addresses

• the practitioner’s staff privileges and faculty appointmappoint

• the practitioner’s reported financial responsibility

• legal actions taken against the practitioner

• board final disciplinary action taken against the practitioner

• any liability claims filed against Podiatric Physicians whichexceed $5,000

• any liability claims filed against M.D.s and OsteopathicPhysicians which exceed $100,000

Optional information may include committees/memberships,professional or community service awards, and publicationsthe practitioner has authored.

How often do I need to review my profile?

If you are a licensed profiled practitioner, you should reviewyour profile information frequently and report any correctionsto the department immediately. By law, you are responsiblefor updating your profile information within 15 days after achange of an occurrence in each section of the profile.

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PrimaryPractice Address

The primarypracticeaddress for thepractitioner

Self-Reported Mandatory Not verified byDOH

PRACTITIONER PROFILE FACT SHEET

Example: John Q. Public, 1234 Profile Drive, Health, FL 55555

SecondaryAddress(es)

The address of a secondarypractice location


Medicaid Indicateswhether or notthe practition-er participatesin the Medicaidprogram

Self-Reported Optional Not verified byDOH

Staff Privileges A list oflicensedhospitals,HealthMaintenanceOrganizations,Prepaid HealthClinics, andAmbulatorySurgicalCenters thatthe practition-er holds staffprivileges.

Self-Reported Mandatoryexcept forAdvancedRegisteredNursePractitioners

Information isverified by thedepartment atthe time of initial licensure.Any changespost-licensureare consideredself-reportedand the licensing boardaccepts andreports theinformation assubmitted bythe practitioner.

Indicate by responding Yes or No - Example: Yes

Example: John Q. Public, 1234 Profile Drive, Health, FL 55555

Example: Institution Name: Health Memorial Hospital, City: Health, State: Florida

GeneralInformation

Description Reported By ReportingRequirement

Verification

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E-Mail Address The practitioner’semail address


Example: [email protected]

Other StateLicensure

A list of statesin which thepractitionerreceived aprofessionallicense and thelicense type.

Self-Reported Optional Information isverified by thedepartment atthe time of initial licensure.Any changespost-licensureare consideredself-reportedand the licensing boardaccepts andreports theinformation assubmitted bythe practitioner.

Example: Jurisdiction: Georgia; Profession: M.D.; Jurisdiction: Alabama;Profession: D.O.

Year BeganPracticing

The year thepractitionerreceived alicense in thisor any otherjurisdiction.



Verification


Example: 1/1/9999

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Provides thename of theschool ortraining pro-gram attendedby the practi-tioner; dates ofattendance;date ofgraduation;and a descrip-tion of all grad-uate medicalor professionaleducationcompleted.

Supportingdocumentationreceived from aprimary source

Mandatory Information isverified by thedepartment atthe time ofinitial licensure.

Example: Institution Name: University of Health or Health UniversityDates of Attendance: 1/1/9999-1/1/0003Graduation Date: 1/1/0003Degree Title: Medical Doctor(MD)

Example:School/University: University of FloridaCity: Gainesville State/Country: FLDates attended From: 1/1/2000Dates attended To:1/1/2003Degree title: Master in Clinical Social Work(MSW) or Doctorate in Pharmacy (Pharm.D)

Educationand Training


Verification

Other HealthRelatedDegrees

Providesinformationabout otherhealth relateddegreesreceived by thepractitioner.

Self-Reported Mandatory Information isnot verified byDOH.

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PRACTITIONER PROFILE FACT SHEETDescription Reported By Reporting

RequirementVerification

ProfessionalandPostgraduateTraining

Providesinformationabout profes-sional andpost-graduatetrainingattendedby thepractitioner..

Self-Reported Manndatory Not verified byDOH

Example:Program Name: Health Memorial Medical CenterProgram Type: ResidencySpecialty Area: Family Practice(FP)Other area: Gynecology(OBGYN)City: HealthState or Country: FLDates Attended From: 1/1/0003Dates Attended To: 1/1/0006

AcademicAppointment


Verification

Providesinformationabout facultyappointmentsthe practition-er receivedwithin the pastten years.


Example:Faculty Title: Asst. Dean of the School of BusinessFaculty Institution: Anywhere UniversityCity : Health, State: FLBegin Date :1/07/0007End Date: PresentStatus: Active

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PRACTITIONER PROFILE FACT SHEETSpecialtyCertification


Verification

Provides information on specialtycertificationsreceived by thepractitioner.

Self-Reported Mandatory Information isverified by thedepartment atthe time of ini-tial licensure.Any changespost-licensureare consideredself-reportedand the licens-ing boardaccepts andreports theinformation assubmitted bythe practitioner.

Example:Specialty board: American Board of Family PracticeCertification: Family Practice (FPDate Certified: 1/1/1000

Indicate your coverage for financial responsibility here. For making updates to your financial responsibility online, please refer to the profession links below to elect a coverage option:Podiatry------http://www.doh.state.fl.us/mqa/podiatry/index.htmlMedicine--- http://www.doh.state.fl.us/mqa/medical/index.htmlOsteopath- http://www.doh.state.fl.us/mqa/osteopath/index.htmlARNP------- http://www.doh.state.fl.us/mqa/nursing/index.htmlChiropratic-http://www.doh.state.fl.us/mqa/chiro/index.html

Information onhow thepractitionerhas elected tocomply withfinancialresponsibilityrequirements.


FinancialResponsibility


Verification

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CriminalOffenses

Description ofany criminaloffenses ofwhich thepractitionerhas beenfound guilty,regardless ofwhether adju-dication ofguilt was with-held, or pledguilty or nolocontendere.

Self-reportedby thepractitioner.

Mandatory Information isverified byDOH at thetime of initiallicensure andrenewal.

Proceedingsand Actions


Verification

Example:Please indicate Yes or No. If yes, complete as follows:Description of offense: Illegal possession of a firearmDate:1/9/1996 Jurisdiction: Health CountyUnder appeal: yesStatus: CorroboratedDate of Corroboration: 1/19/1997

MedicaidSanctions andTerminations

Indicateswhether thepractitionerhas beensanctioned orterminated forcause fromparticipation inthe Medicaidprogram.

Self reportedby the practi-tioner, report-ed by DOH, orreporteddirectly fromthe source.

Mandatory Information isverified byDOH throughthe Agency forHealth CareAdministration.

Example:Please indicate Yes or No to each of the questions.

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FinalDisciplinaryActions (withinlast 10 years)

Indicates finalactions takenby the depart-ment withinthe last tenyears.

Self-reportedby the practi-tioner andreported bythe depart-ment.

Mandatory Information isverified byDOH throughthe NationalPractitionerData Bank.

Example:Please indicate Yes or No. If yes, complete as follows:Action taken by: American Board of SurgeryDate: 1/1/2002Description of disciplinary action: RevokedUnder Appeal: yes

Final discipli-nary actiontaken by a spe-cialty boardwithin the pre-vious 10 years

Indicates finalaction taken bya specialtyboard recog-nized by thedepartment.

Self-Reported Mandatory Information isverified byDOH throughthe NationalPractitionerData Bank.

Final discipli-nary actiontaken by alicensingagency withinthe previous 10years

Indicates finalactions takenby a licensingagency regu-lating the prac-titioner’slicense inFlorida or anyother jurisdic-tion.

Self-reportedby the practi-tioner as wellas directly fromthe source.


Example:Please indicate Yes or No. If yes, complete as follows:Action taken by: Department of HealthDate: 1/1/2001Description of disciplinary action: SuspensionUnder Appeal: yes

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Final disciplinaryaction taken bya health mainte-nance organiza-tion, pre-paidhealth clinic,nursing home,out-of-state hos-pital or out-of-state ambulato-ry surgical cen-ter within theprevious 10years

Indicates finalaction taken byan institution,such as ahealth mainte-nance organi-zation, clinic ornursing home.

Self-reportedby the practi-tioner as wellas directly fromthe source.


Example:Please indicate Yes or No. If yes, complete as follows:Date: 1/1/1999Related to professional competence: NoRelated to delivery of service: Yes

Resigned fromor had anymedical staffprivilegesrestricted orrevoked withinthe previous 10years by ahealth mainte-nance organiza-tion, pre-paidhealth clinic,nursing home,out-of-statehospital or out-of-state ambu-latory surgicalcenter

Indicates infor-mation relatedto restriction,resignation orrevocation ofstaff privilegesto settle apending disci-plinary action.

Self-Reported Mandatory Information isverified by DOHthrough theNationalPractitionerData Bank.

Example:Please indicate Yes or No. If yes, complete as follows: Taken by: Health Memorial Date: 1/1/1999Description of disciplinary Action: 30 day suspension of staff privilegesUnder Appeal: No

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Liability ClaimsExceeding$100,000.00(within last 10years).

Indicates anyaction or claimproviding thedate, county,case number,settlementdate, amountand policyamount forpersonal injuryalleged to havebeen caused.

Self-reportedby the practi-tioner, andreporteddirectly to DOHfrom theDepartment ofFinancialServices.

Mandatory forM.D.s andOsteopathicphysicians toreport to theDepartment ofFinancialServices (DFS).DOH isrequired topublish allclaims receivedfrom DFS.

Information isverified by theNationalPractitionerData Bank.

Example:Please indicate by Yes or No. If yes, complete as follows:Incident date: 1/1/1999County: Health Judicial case: cl-99-9999Settlement date: 1/12001Amount: $150,000.00Policy amount: $750.000.00

Liability ClaimsExceeding$5000.00(within the last10 years)

Indicates anyaction or claimproviding thedate, county,case number,settlementdate, amountand policyamount forpersonal injuryalleged to havebeen caused.

Self-reportedby the practi-tioner andreporteddirectly to DOHfrom theDepartment ofFinancialServices.

Mandatory forPodiatric physi-cians to reportto theDepartment ofFinancialServices (DFS).DOH isrequired topublish allclaims receivedfrom DFS.

Information isverified by theNationalPractitionerData Bank.

Example:Please indicate by Yes or No. If yes, complete as follows:Incident date: 1/1/1999County: Health Judicial case: cl-99-9999Settlement date:1/12001Amount: $150,000.00Policy amount: $750.000.00

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Bankruptcies Indicates anybankruptcy infor-mation receivedby the depart-ment against thepractitioner. If nobankruptcy infor-mation has beenreceived, this fieldwill not show inthe profile.

Self-reported bythe practitioneras well asdirectly fromthe source

Not required bythe practitioner,but any infor-mation in pos-session of thedepartment isreported forM.D.s, andOsteopathicand Podiatricphysicians

Not verified byDOH

Committees/Memberships

A list of anycommittees onwhich the practitionerserved for anyhealth entity withwhich they areaffiliated.

Self-reported Optional Not verified byDOH

OptionalInformation


Verification

Example: Committee/Membership: MQA Profile Team

Professional orCommunityService Awards

A list of anyprofessional orcommunityservice activi-ties, honors, orawardsreceived by thepractitioner.


Example:Community Service/Award/Honor: Big Health Bend Organization: Health Memorial Hospital

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Publications A list of publica-tions authoredby the practi-tioner and pub-lished in peer-reviewed med-ical or nursingliterature. Profileincludes publi-cation title andthe year it waspublished.


Example: Title: Health RelatedPublication: New MQA Health JournalDate: 1/1/0007ProfessionalWeb Page

A link to thepractitioner’sprofessionalwebsite.


Example: Professional web page: www.doh-mqaservices.com

LanguagesOther ThanEnglish

Languages,other than Self-ReportedEnglish, that thepractitioneruses to commu-nicate withpatients or any-translation serv-ices available topatients at thepractitioner’sprimary place ofpractice.


Example: Language: Spanish

OtherAffiliations

A list of anynational, state,local, county, orprofessionalaffiliations.


Example: Affiliation: Physician Association

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UPDATING YOUR PROFILE

Changes (excluding medical malpractice) can be made to yourprofile electronically, using your Account/User ID and Password atwww.FLHealthSource.com. Any Medical Malpractice changesshould be faxed to (850) 245-4791. If you have any questionsregarding your Account/User ID and Password or about updatingyour profile, you can contact a Profiling Specialist at (850) 488-0595, extension 3 for assistance, Monday through Friday, from 8:00a.m. until 5:00 p.m., excluding state holidays.

• Go to www.FLHealthSource.com

• Click on Licensee/Provider

• Click on Update Profile

• Login by entering your profession, Account/User ID, and Password

• Select “Update Personal Profile” on the left side of the page and revieweach section of the profile

• Once you have completed your review and made any necessary corrections, click on Confirm Changes

• The Practitioner Confirmation Page will display the information that will bepublished online, at which time you must confirm the profile again beforethe changes will be implemented

CONTACT INFORMATION

Web site: www.FLHealthSource.com

E-mail: [email protected]

Telephone: (850) 488-0595

Fax: (850) 245-4791

Mailing Address:

Department of Health

Division of Medical Quality Assurance

Bureau of Operations – Licensure Support Services Unit

4052 Bald Cypress Way, Bin #C-10

Tallahassee, Florida 32399-3260

www.FLHealthSource.com

Last Updated 10/30/13 - Florida Department of Health...2013/10/30 · • the practitioner’s...

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