Florida

Board

of

Optometry

Name changes require legal documentation showing the name change. To change your name, please submit supporting documents, which must be one of the following:

1. A copy of a state issued marriage license that includes the original signature and seal from the clerk of the court.
2. A divorce decree restoring your maiden name.
3. A court order showing the name change (adoption, legal name change, federal identity change).
4. A copy of a certificate of naturalization or H1B Employment Visa (Note: Foreign applicants and/or licensees may not have state issued documents)

Any one of these will be accepted unless the department has a question about the authenticity of the document.

The Division of Medical Quality Assurance is now issuing electronic licenses, which enables you to download a PDF copy of your license within two business days. The license can be retrieved in the License Documents menu of your MQA Online Services Portal, https://mqa-vo.doh.state.fl.us/datamart/voservicesportal account. To learn more, please visit the electronic licensing webpage at https://flhealthsource.gov/electronic-licensing/.

For requests by mail, please include your full name as it appears on your license, profession, license number, your new name, your date of birth, the last four digits of your social security number, and your signature. Please submit your name change along with supporting document(s) 5-7 business days to allow processing if you need to renew online.

If you do not require a new license to reflect your new name, you may submit your request online or by mail along with legible supporting document(s) to one of the following:

•  Log onto your MQA Online Services Portal account , select “Request Name Change” from the “Manage My License” dropdown menu
• Mailing address – DOH, Division of Medical Quality Assurance, Post Office Box 6320, Tallahassee, Florida 32314-6320

The 2013 legislative session brought very important changes for the practice of optometry. On April 19, 2013, Governor Rick Scott signed HB-239 into law, which significantly increased the scope of practice of optometry. One of those changes impacts when and how adverse incidents in the practice of optometry are reported to the Department of Health.

Effective January 1, 2014, certified optometrists will be required to report to the Department of Health any adverse incidents in the practice of optometry. An adverse incident is defined to mean, “any of the following events when it is reasonable to believe that the event is attributable to the prescription of an oral ocular pharmaceutical agent” by a certified optometrist:

• Any condition requiring a patient’s transfer to a hospital;
• Any condition that requires care and treatment from a physician, other than a referral or consultation;
• Permanent physical injury to the patient;
• Partial or complete permanent loss of sight by the patient; or
• Death of the patient.

The reports must be:

• Sent by certified mail; and
• Postmarked within 15 days after the adverse incident occurs.

Mail the completed Adverse Incident Form to:

Department of Health
Consumer Services Unit
4052 Bald Cypress Way, Bin C75
Tallahassee, FL 32399-3275

Licensees Only

You may update your address using Online Services.

Address changes for licensees may also be made by providing your name, old address and new address to:

Email: info@floridasoptometry.gov
Fax: (850) 922-8876

OR

U.S. Mail:

DOH, MQA
4052 Bald Cypress Way
Bin C01
Tallahassee, FL
32399-3251

Applicants Only

Address changes for applicants may be made by providing your name, old address and new address to:

Email: info@floridasoptometry.gov
Fax: (850) 922-8876

OR

Florida Board of Optometry
4052 Bald Cypress Way
Bin C07
Tallahassee, FL
32399-3257

The Division of Medical Quality Assurance is now issuing electronic licenses, which enables you to download a PDF copy of your license within two business days. The license can be retrieved in the License Documents menu of your MQA Online Services Portal, https://mqa-vo.doh.state.fl.us/datamart/voservicesportal account. To learn more, please visit the electronic licensing webpage at https://flhealthsource.gov/electronic-licensing/.

Board members are appointed by the governor and confirmed by the Senate. You may apply by contacting the Governor’s Appointment Office, LL10 The Capitol, Tallahassee FL 32399-0001; or by calling (850) 488-2183.

You must submit your request in writing. Mail or fax your signed request to the Board Office. Please visit our Contact Information page for the mailing address and fax number.

Profiles can be accessed by on our License Verification screen. If the health professional is licensed in one of profiled professions, a “Practitioner Profile” tab will be available.

Log into your MQA Online Services Portal account and select Request Duplicate License from the “Manage My License Information” pulldown menu. Review your changes and click “Submit.”

NOTE: Your license should be retrievable through the MQA Online Services Portal within 2 business days after your order is complete. If your profession is pending renewal or in a current renewal cycle, you may be asked to renew your license instead of being issued a duplicate license.

Make cashier’s check or money order payable to the Board/Council to be researched, in the amount of $25.00, for each verification requested.

• • Include name and address where verification is to be sent
  • Verification of Licensure order form
  • Non-Licensure Verification order form

Mail your request and fee to:
Division of Medical Quality Assurance
Licensure Support Services Attn: License Verifications
P.O. Box 6320
Tallahassee, FL 32314-6320

Other Important Information:

• Requests for licensure verification received without the appropriate fee will be returned unprocessed to the sender.
• The Division of Medical Quality Assurance cannot guarantee your verification will meet the deadlines for other State Boards. The current processing time for licensure verifications is approximately 10 days from receipt. Please check your deadline dates before you submit your verification request.
• Release forms from the licensees are not required for verifications.

Exemptions: Financial information, medical information, school transcripts, examination questions, answers, papers, grades and grading keys, are confidential and exempt forms pursuant to Section 119.071, Florida Statutes, and will be withheld pursuant to Section 456.057, Florida Statutes. Social Security numbers will also be redacted pursuant to 42 U.S.C. 405(c)(2)(C) (vii)(1).

If you need a written statement on a public record attesting to the record’s genuineness or that it is a true and correct copy, you may fill out the Online Request Form. Be sure to indicate you need a certified copy of the request form. A $25 fee will be charged, in addition to the public record Fees and Charges. Visit our Public Records page for information on how to request certified documents by mail.

You may learn more about the Complaint process and submit the appropriate complaint forms by visiting our online Enforcement website.

Intern hours are recorded on the Internship Affidavit Report form attached to the application.

You may check the status of your application in real time via our Online Services, using your User ID and password. If you lose your User ID and password, contact Licensure Support Services at (850) 488-0595 to get this information.

You may use our License Look-Up Search screen.

Any substantially affected person (i.e. a licensee or applicant) may seek a Declaratory Statement. Declaratory statements regarding an opinion of a board, or the department when there is no board, as to the applicability of a statutory provision, or of any rule or order of the board, or department when there is no board, as it applies to the licensees particular set of circumstances, pursuant to Section 120.565, Florida Statutes. The petition seeking a declaratory statement must state with particularity the licensees set of circumstances and must specify the statutory provision, rule, or order that the licensee believes may apply to the set of circumstances.

By visiting the board’s meetings page. Scroll to the bottom of the page and click on either past or upcoming meetings. Review the meeting dates to locate the agenda you need, and the board’s agenda should be posted on the right under Materials.

To view a list of actively licensed practitioners, use the License Verification Search and select the county and profession from the drop-down list.

Visit our Enforcement Website to download and complete our Unlicensed Activity Complaint Form. Before completing your complaint form, please be sure to review all instructions provided on the first page.

You may visit our online License Verification page.

You may utilize this service to see the status of your providers license and whether there are any disciplinary cases or public complaints against the licensee.

You can print a confirmation of license through the Practitioner Login feature of MQA Services.

The confirmation is available up to 30 days after you submit your online renewal request. After logging into the system with your User ID and password, select Print Confirmation of License from the navigation bar located on the left.

You can view, confirm, or make changes to the information that will be published in your practitioner profile by logging in to Online Services.

In carrying our legislative mandate to publish practitioner profiles, we want to ensure the information that we publish is accurate. Accordingly, we ask that you please review your profile for any changes, corrections, and/or omissions. If you see the statement “The practitioner did not provide this mandatory information”, please provide that information. We will not accept curriculum vitae or resumes in place of you providing specific information. Changes, excluding education and training, year began practicing, and liability claims, can be made to your profile electronically by following the instructions below.

You may also submit changes by mail to:

Department of Health
Licensure Support Services
4052 Bald Cypress Way, Bin C-10
Tallahassee, Florida 32399-3260

Please note that Section 456.042, Florida Statutes, requires practitioners to update profile information within 15 days after a change of an occurrence in each section of your profile. Attention Newly Licensed Practitioners Section 456.041(7), Florida Statutes, requires you to submit changes to the department within thirty (30) days from receipt of notice. If you do not make changes within thirty (30) days, your profile will be automatically published. 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 be published online, at which time you must “Confirm” the profile again before the changes will be implemented.

Note: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

For Dentists, Medical Doctors and Osteopathic Physicians – To provide expert testimony concerning the prevailing professional standard of care, you must either be licensed in Florida OR you must possess an expert witness certificate.

To apply for an “Expert Witness Certificate”:

1. Go to our Online Application Login page
2. First time users must create an account by clicking on the “Create an Account button” and following the prompts
3. Once you have created an account, select your profession from the “Board/Council” drop down menu
4. Under the “Profession” drop down menu, select either “Dental Expert Witness Certificate”, “Medical Doctor Expert Witness Certificate” or “Osteopathic Physician Expert Witness Certificate”
5. Enter your email address and password and click “Login”

Below are the statutes and rules providing the requirements for requesting a Petition for (Variance from) or (Waiver of) Rule (Citation)

Florida Statutes – 120.542 Variances and waivers

Florida Administrative Code (Rules) Chapter 28-104: Variance OR Waiver