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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: A non-renewable limited scope temporary permit may be issued to an applicant only once. This permit is valid for a non-renewable period of not more than thirty (30) days.
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.