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The Non-Renewable limited scope temporary medical permit shall be limited to a specific activity, function, series of events or purpose, and to a specific geographic area within the state, which limitations shall be stated on the face of the permit.
Note: This permit is valid for a non-renewable period of not more than thirty (30) days for each specific activity, function, series of events or purpose.
If you have answered any of the questions on the application “yes” you must submit a notarized affidavit detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment the amount paid in your behalf. If applicable please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of your statement.