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!
PRIORITY #1
1. Write a letter to the Medical Staffing departments of the hospitals 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, 1700 S. Tamiami Trail, Sarasota, FL 34239
- Cape Surgery Center, 1941 Waldemere Street, Sarasota, FL 34239
- Doctors Same Day Surgery Center, 5731 Bee Ridge Road, Sarasota, FL 34233
(In this letter, state that you are a resident, 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.
PRIORITY #2
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: Vicki Woods.
- your CV
- medical school certificate
- medical license
- internship certificate
- DEA Certificate
- residency certificate
- copy of social security card
- laser certification
- state photo ID driver’s license
- applications to EACH 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.
DEA PROTOCOLS
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.