Forms
- DH-MQA 1112 Out-of-State Midwife Applicant
- DH-MQA 1111 Foreign-Trained Midwife Applicant
- DH-MQA 1051 Application for Midwifery Licensure by Examination
- Mobile Opportunity by Interstate Licensure Endorsement
- DH-MQA 5013 Temporary Certificate Application to Practice in Areas of Critical Need (Rev. 08/15)
- Address Change Form
- Name Change Form
Apply Online
Eliminate mailing time and expedite your application. Receive a response within 10-13 business days.
Reporting and Practice
- DH-MQA 5011 Annual Report of Midwifery Practice
- DH-MQA 1057 Collaborative Management Agreement
- DH-MQA 1077 Emergency Backup Plan for Delivery
- DH-MQA 1047 Informed Consent for Licensed Midwifery Services
- DH-MQA 5029 Adverse Incident Reporting for Planned Out-of-Hospital Births
Licensure Types
Licensure by Examination
Licensure byย examinationย is the appropriate method for applicants who are not licensed in another state or country, or for applicants who are licensed in another state or country whose licensing requirements are significantly dissimilar to licensing requirements in Florida.
Mobile Opportunity by Interstate Licensure Endorsement
Licensure by MOBILEย endorsementย is the appropriate method for applicants who are licensed in another stateย with a similar scope of practice and who have actively practiced the profession for at least three year.
Requirements
To be licensed as a midwife in Florida through the MOBILE Endorsement pathway you must meet the following requirements inย section 456.0145, Florida Statutes:
- Must hold an active, unencumbered license issued by another state, the District of Columbia, or a territory of the United States in a profession with a similar scope of practice, determined by the board or the department, as applicable.
- Must have obtained a passing score on a national licensure examination for the profession.
- Must have actively practiced the profession for at least three years during the four-year period immediately preceding the date of submission of this application.
- Must not have ever been reported to the National Practitioner Data Bank, unless the applicant successfully appealed to have the report removed.
- Must not be the subject of a disciplinary proceeding in a jurisdiction in which he or she holds a license or by the United States Department of Defense for reason related to the practice of the profession for which the applicant is applying.
- Must not have had disciplinary action taken in the five years immediately preceding the date of submission of the application.
Pursuant toย section 456.0145(2)(c), Florida Statutes, an applicant is ineligible for endorsement if they:
- Have a complaint, an allegation, or an investigation pending before a licensing entity in another state, the District of Columbia, or a possession or territory of the United States;
- Have been convicted of or pled nolo contendere to, regardless of adjudication, any felony or misdemeanor related to the practice of a health care profession;
- Have had a health care provider license revoked or suspended by another state, the District of Columbia, or a territory of the United States, or have voluntarily surrendered any such license in lieu of having disciplinary action taken against the license;ย or
- Have been reported to the National Practitioner Data Bank, unless the applicant has successfully appealed to have his or her name removed from the data bank.
Temporary Licensure in an Area of Critical Need
Temporary licensure in an area of critical need allows a midwife who is pursuing licensure by endorsement to work under the supervision of a physician in a specific area of critical need.
An application for licensure by endorsement must be received in addition to the application for temporary licensure.
Fees
Fees must be paid prior to the processing of your application for licensure. Applications received without fees may be returned without processing. Fees should be included with your application, and paid by cashierโs check or money order, payable to the Florida Department of Health.
All applications expire one year from the date the application is received by the Department. A refund of fees may be requested for the refundable portion within three years of expiration or upon withdrawal of the application.
| Licensure by Examination | |
|---|---|
| Application Fee (non-refundable) | $200 |
| Initial Licensure Fee | $500 |
| Unlicensed Activity Fee | $5 |
| TOTAL FEES: | $705 |
| Licensure by Endorsement | |
|---|---|
| Application Fee (non-refundable) | $200 |
| Endorsement Fee | $250 |
| Licensure Fee | $500 |
| Unlicensed Activity Fee | $5 |
| TOTAL FEES: | $955 |
| 4 Month Pre-licensure Evaluation | |
|---|---|
| (required for endorsement applicants) | $100 |
| Temporary Certificate in an Area of Critical Need | |
|---|---|
| Application Fee (non-refundable) | $200 |
| Temporary Certificate Fee | $50 |
| Unlicensed Activity Fee | $5 |
| TOTAL FEES: | $255 |