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DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 COMMUNITY PHARMACY PERMIT APPLICATION AND INFORMATION DECEMBER

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How to fill out dh mqa 1214 form

Point by point on how to fill out DH MQA 1214 form and who needs it:

01

The DH MQA 1214 form is used by individuals who are applying for a medical license in the state of Florida.

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To begin filling out the form, provide your personal information such as your name, address, and contact details.

03

Indicate your social security number and date of birth in the designated sections.

04

Specify the type of license you are applying for, such as Physician, Physician Assistant, or Medical Resident.

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Include information about your medical education, including the name of the school, dates of attendance, and degrees obtained.

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Provide details about your postgraduate training, including the institution, specialty, and dates of training.

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If you have any prior disciplinary actions or criminal convictions, disclose this information accurately.

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Attach any supporting documents required by the form, such as transcripts, certifications, or letters of recommendation.

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Sign and date the form before submitting it to the relevant licensing board or regulatory agency.

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Make sure to review the completed form for accuracy and completeness before submission.

The DH MQA 1214 form is specifically required by individuals who are applying for a medical license in the state of Florida. This includes physicians, physician assistants, and medical residents who wish to practice medicine within the state. It is important to carefully fill out the form and provide accurate information to ensure a smooth application process.

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