Upon receipt of your Fellowship Acceptance, the steps listed below must be completed immediately. Each is listed in order of priority; however, this is subject to change. Please use this form as a checklist for your application process. Expediency is important!
1. Write a letter to the Medical Staffing department of the hospital listed below. Indicate your “intent to practice” from July 1, through June 30, under the auspices of Dr. Herbert Silverstein. Copies of all correspondence must be sent to ERF.
- Sarasota Memorial Hospital and Cape Surgery Center
- 1700 S. Tamiami Trail, Sarasota, FL 34239
- OR email Ann Baker at [email protected]
In this letter, state that you are a fellow, working with Drs. Silverstein, Wazen and Rosenberg and you have been informed that you will be applying for Consulting privileges, only.
2. Apply for your Florida medical license IMMEDIATELY. Telephone (805) 487-2252 to request an application or write to:
Department of Professional Regulations
Board of Medicine
1940 North Monroe Street
Tallahassee, FL 32399-0770
3. Return your Sarasota Memorial Hospital APPLICATION IMMEDIATELY – REGARDLESS OF THE STATUS OF YOUR FLORIDA MEDICAL LICENSE. Your application must be presented to four separate committees before the Board passes final approval. It is imperative that this process begins immediately.
You must obtain Laser Certification prior to starting the Fellowship. The lasers in which you will need certification are: KTP, HGM, and the CO2.
Send copies of the following to: Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, ATTN: Grace Cantley.
- your CV
- medical school certificate
- medical license (as soon as you have it)
- internship &/or residency certificate (as soon as you have it)
- DEA Certificate or number
- copy of social security card
- laser certification (as soon as you have it)
- state photo ID driver’s license
- copy of applications to the hospital from Priority #1
ALL OF THE AFOREMENTIONED ITEMS MUST BE HANDLED IN AN EXPEDIENT MANNER.
Failure to comply could result in the loss of your Fellowship and/or failure to obtain hospital privileges.
WITH AN OUT-OF-STATE DEA CERTIFICATE:
- 15 days prior to coming to Sarasota, FAX a letter to the Florida DEA, Attn: Registration @ (305) 590-4880, and state the following:
- Address on the present DEA certificate
- Medical license number from that state
- DEA Number
- The new working address in Florida
- Remember to sign the letter!
WITHOUT A DEA CERTIFICATE:
- There is a $210 fee.
- The certificate is valid for 3 years.
- Apply for Full Schedule 2, 2n, 3, 3n, 4 and 5.