The 44 Florida forms that ask for a clinician's input, from the DWC-25 and PIP forms to Baker Act certificates, school and sports physicals, and the yellow DNRO.
This page lists the 44 Florida forms that ask for a clinician's input, grouped by program. On workers' comp claims the authorized treating physician reports on the DWC-25, the Uniform Medical Treatment/Status Reporting Form. Baker Act examinations start with the CF-MH 3052b, the Certificate of Professional Initiating Involuntary Examination. Schools need the DH 680 Certification of Immunization from Florida SHOTS and the DH 3040 entry exam, and athletes need the FHSAA EL2 physical. Medicaid long-term care eligibility uses the AHCA 5000-3008.
Several Florida forms have strict signing rules. The DNRO, DH Form 1896, must be printed on yellow paper, and the PIP disclosure form OIR-B1-1571 needs the provider's own wet signature; it can't be sent electronically, and signature on file isn't accepted. The PIP eligibility and services certifications must be notarized. Medical marijuana orders are entered in the state registry after an in-person exam, and the physician personally obtains the DH-MQA-5026 consent. 4 forms here have a Spanish version, including the DNRO.
Reports work-relatedness, major contributing cause, diagnosis, treatment plan and authorization requests, functional limitations/restrictions, and MMI/permanent impairment rating for an injured worker.
Written expert medical opinion on disputed medical issues (conflicting provider opinions, health care services, reimbursement disputes) for a Judge of Compensation Claims or the Division under s. 440.13(9), F.S.
FR-13BFlorida-licensed treating physician reports diagnosis, prognosis/MMI, functional capacity and in-line-of-duty causation to establish total and permanent disability for FRS regular or in-line-of-duty disability retirement (Rule 60S-4.007).
Applies for ADA paratransit (Special Transportation Service) eligibility in Miami-Dade County; the physician's medical verification documents why the applicant cannot use Metrobus/Metrorail/Metromover.
Medical certification of a disability for Florida Transportation Disadvantaged (state-funded) door-to-door service in Orange, Osceola and Seminole counties when the applicant qualifies on disability rather than income/no-bus grounds.
Florida-certified physician or medical professional's certification of a disability for a HART discount disabled permit on local bus routes.
Mandatory PIP form signed at the initial treatment in which the insured affirms services were rendered and explained and the treating professional certifies the bill and coding are proper, as required by s. 627.736(5)(e), F.S.
Sworn, notarized certification that a provider entity qualifies to receive PIP medical benefits under s. 627.736(1)(a), F.S. (practitioner-owned, hospital-owned, or an accredited or qualifying licensed health care clinic).
Sworn, notarized certification that PIP medical services or care were lawfully provided, supervised, ordered or prescribed by a Florida-licensed MD/DO, dentist or chiropractic physician.
Health care professional's medical certification used by CARES to determine medical (nursing facility level of care) eligibility for Medicaid institutional care (ICP) and long-term care/HCBS waiver, also usable as a patient transfer form.
DH 3040Certifies the health examination required within one year before entry into a Florida school (s. 1003.22, F.S.); also used for child care/pre-K entry.
Confirms that a student-athlete completed a qualifying electrocardiogram (ECG on or after July 1, 2024), required from July 1, 2026 for incoming 9th graders and new 10th-12th grade athletes.
Annual preparticipation history, physical exam and medical eligibility required before a student practices or competes in FHSAA sports; valid 365 days.
Clinician follow-up clearance used when the ECG screening (EL1) or the physical (EL2) requires further evaluation before eligibility.
Medical doctor's exemption of a student-athlete from the FHSAA ECG screening requirement.
Required certificate documenting a child's immunizations (Part A) or a temporary (Part B) or permanent (Part C) medical exemption for entry to preschool, K-12, licensed child care and family day care homes.
Medical statement supporting a meal modification (disability-related diet, allergy, texture or substitution) in the USDA school meal programs (NSLP/SBP), as required by 7 CFR 210.10(m) and Section 504/ADA.
Medical documentation required by 7 CFR 246.10(d) for WIC to issue exempt infant formula, WIC-eligible nutritionals or non-contract formula, and to modify WIC foods, for a participant with a qualifying medical condition.
Referral to WIC with the provider's anthropometric and lab data (height/length, weight, hemoglobin) and nutrition-risk information, used to certify the patient for WIC.
DH Form 1896Florida's statutory pre-hospital DNRO directing EMS and medical personnel not to resuscitate after respiratory or cardiac arrest (s. 401.45, F.S.; Rule 64J-2.018).
Voluntary portable physician order recording CPR, medical intervention and nutrition preferences for seriously ill Floridians.
Certifies that a qualified professional personally examined the person within the preceding 48 hours and that they appear to meet Baker Act criteria for involuntary examination, initiating transport to a receiving facility.
Receiving-facility petition to the court for involuntary inpatient services, supported by the opinions of a psychiatrist and a second professional who examined the person.
Physician's or psychiatric nurse's finding on whether a person at a receiving or treatment facility is competent to give express and informed consent to voluntary admission and to treatment.
Examiner's determination that a person held for involuntary examination does not meet criteria for involuntary inpatient or outpatient services and may be released.
Certifies that a qualified professional examined the person and found them substance-use impaired and appropriate for emergency admission under the Marchman Act, with a recommended level of care.
Physician's certification that a resident of a nursing home or assisted living facility (ch. 400/429 F.S.) is competent to consent to voluntary admission and treatment before transfer to a receiving facility.
Documents a non-receiving hospital physician's determination, after examination, that a person brought under a Baker Act initiation does not meet involuntary criteria and may be released.
Facility petition asking the circuit court to adjudicate a patient incompetent to consent to mental health or medical treatment and appoint a guardian advocate, supported by a psychiatric professional's opinion.
Physician's certification that a patient is incompetent to consent to treatment, with notice that a health care surrogate or proxy will make decisions.
Petition for court-ordered involuntary outpatient treatment (Florida's assisted outpatient treatment), supported by a psychiatrist's and a second professional's opinions and a proposed treatment plan.
Qualified physician certifies a patient with a qualifying condition and enters the medical marijuana order (route, amount, up to a 70-day supply per order) in the state registry.
DH-MQA-5026Board-mandated written informed consent that the qualified physician must personally obtain each time a medical marijuana certification is issued; Part B covers smokable marijuana for patients under 18.
Written (fax) report of suspected child abuse, abandonment or neglect, or abuse, neglect or exploitation of a vulnerable adult, to the Florida Abuse Hotline under Chapters 39 and 415, F.S.
Online submission of a report of suspected child abuse/neglect/abandonment or vulnerable adult abuse/neglect/exploitation to the Florida Abuse Hotline.
Notifies the Florida Department of Health (via the county health department) of a reportable disease or condition diagnosed or suspected by a practitioner under Rule 64D-3.029, F.A.C.
Florida physician certifies that a patient depends on electric-powered equipment to avoid loss of life or immediate hospitalization so the account is designated Medically Essential Service (pre-disconnection and storm notices) for 12 months.
Physician certifies that a homestead owner is totally and permanently disabled (quadriplegia, paraplegia, hemiplegia, legal blindness, or another disability requiring a wheelchair) for the Florida property-tax exemptions under s. 196.101 and the $500 disability exemption.
Physician certifies that a first responder is totally and permanently disabled by a line-of-duty impairment, for the full homestead property-tax exemption under s. 196.102.
Optometrist certifies that a homestead owner is totally and permanently disabled due to legal blindness for Florida property-tax exemptions.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The authorized treating physician, or another health care provider within their area of expertise. The DWC-25 covers work-relatedness and major contributing cause, diagnosis, treatment plan and authorization requests, functional limitations and restrictions, and MMI with any permanent impairment rating. It goes to the insurer or carrier under the filing rules in Rule 69L-7. The Division also publishes it as a flat PDF, an Excel workbook and a Word file.
A psychiatrist, physician, clinical psychologist, psychiatric nurse, LCSW, mental health counselor, marriage and family therapist, physician assistant or APRN, on form CF-MH 3052b. The professional must have personally examined the person within the preceding 48 hours and must give DSM or ICD diagnosis codes and describe the behaviors. The certificate goes with the person to the receiving facility, which sends a copy to the DCF Baker Act Reporting Center.
Print it from Florida SHOTS. There is no blank DH 680: enrolled providers generate the certified form with an electronic signature, and county health departments can issue it too. Part A records complete immunizations, Part B a temporary medical exemption with an expiration date, and Part C a permanent medical exemption with written clinical reasons. The parent gives it to the school or child care, and enrolled schools can also see it in Florida SHOTS.
Yes. DH Form 1896 must be printed on yellow paper, in any shade, before it is completed, and copies need a full-page yellow background, because EMS is only required to honor yellow forms. A Florida-licensed physician, osteopathic physician, autonomous APRN or PA signs it with the patient or representative. Florida's POLST is maintained by FMDA rather than the state, and EMS DNR still requires the DNRO or its patient identification device.