Limited License Psychologist

Personal History documentation must include: date(s), location(s), specific circumstances, practitioners, facilities and treatment involved, etc. Your “yes” answers must be substantiated by official documents sent directly to us from treating physicians/practitioners/facilities.  Documentation from health care facilities and/or health care practitioners may indicate whether, based on the organization or individual’s professional opinion regarding services provided to you, it has been determined that you are able to safely render services to the public.

Disciplinary History documentation must include: Board orders, disciplinary reports, court documents, arrest records, sentencing information, final disposition(s), restitution records, completion of probation, employment records and/or employment verifications, employer and/or colleague recommendation letters, etc.

Criminal History documentation must include for each offense: court and arrest records, sentencing information, final disposition(s), restitution records, proof of completion of probation and all other sanctions. If the records are no longer available, must have certification of their unavailability from the applicable clerk of courts office.

Effective July 1, 2012, Section 456.0635, Florida Statutes (F.S.), provides that health care boards or the department shall refuse to issue a license, certificate or registration and shall refuse to admit a candidate for examination if the applicant:

1. Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under Chapter 409, F.S., (relating to social and economic assistance), Chapter 817, F.S., (relating to fraudulent practices), Chapter 893, F.S., (relating to drug abuse prevention and control) or a similar felony offense(s) in another state or jurisdiction unless the candidate or applicant has successfully completed a drug court program for that felony and provides proof that the plea has been withdrawn or the charges have been dismissed. Any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration, unless the sentence and any subsequent period of probation for such conviction or plea ended:
   • For the felonies of the first or second degree, more than 15 years from the date of the plea, sentence and completion of any subsequent probation;
   • For the felonies of the third degree, more than 10 years from the date of the plea, sentence and completion of any subsequent probation;
   • For the felonies of the third degree under section 893.13(6)(a), F.S., more than five years from the date of the plea, sentence and completion of any subsequent probation;
2. Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under 21 U.S.C. ss. 801-970 (relating to controlled substances) or 42 U.S.C. ss. 1395-1396 (relating to public health, welfare, Medicare and Medicaid issues), unless the sentence and any subsequent period of probation for such conviction or pleas ended more than 15 years prior to the date of the application;
3. Has been terminated for cause from the Florida Medicaid program pursuant to section 409.913, F.S., unless the candidate or applicant has been in good standing with the Florida Medicaid program for the most recent five years;
4. Has been terminated for cause, pursuant to the appeals procedures established by the state or Federal Government, from any other state Medicaid program, unless the candidate or applicant has been in good standing with a state Medicaid program for the most recent five years and the termination occurred at least 20 years before the date of the application;
5. Is currently listed on the United States Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities.