Application for Health Professional Practice Executive Order
This file is an application for health professionals to practice in Tennessee under an executive order. It is specifically for licensees from other states assisting in the medical response to COVID-19. The application is free of charge and must be submitted by mail.
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How do I fill this out?
To fill out this application, begin by providing your personal information in the designated fields. Ensure that all requested attachments are included, such as a copy of your identification. Once completed, submit the application via email as specified.
How to fill out the Application for Health Professional Practice Executive Order?
1
Print the application form.
2
Fill in your personal information accurately.
3
Attach a legible copy of your driver's license or photo ID.
4
Review your application for completeness.
5
Submit the completed application via email.
Who needs the Application for Health Professional Practice Executive Order?
1
Medical professionals from other states relocating to Tennessee.
2
Healthcare workers assisting in the COVID-19 response.
3
Physicians and physician assistants wanting to practice temporarily.
4
Nurses seeking to provide support during health emergencies.
5
Any licensed health professional needing temporary permission to practice.
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What are the instructions for submitting this form?
To submit this form, email the completed application to TN.Health@tn.gov with the required subject line. Make sure to attach a copy of your identification as well as any supporting documents. If you prefer, you can also fax your application to the provided numbers on the form.
What are the important dates for this form in 2024 and 2025?
For 2024, the application remains valid until May 18. Ensure you submit before this date for consideration. The same deadline applies for 2025, so stay updated on any changes to regulations.
What is the purpose of this form?
The purpose of this form is to grant temporary medical practice authorization to health professionals from other states in Tennessee. It aims to ensure that needed medical personnel can assist in critical health situations, such as the COVID-19 pandemic. This application facilitates a rapid response to health emergencies, allowing licensed professionals to contribute to public safety efficiently.
Tell me about this form and its components and fields line-by-line.
- 1. Name: Full name of the applicant.
- 2. Social Security Number: To verify identity.
- 3. Facility Address: Location where the applicant intends to practice.
- 4. Date of Birth: To confirm age eligibility.
- 5. Current Licenses: Information on existing medical licenses.
- 6. Competency Questions: To assess the applicant's professional history and conduct.
What happens if I fail to submit this form?
Failing to submit this form may lead to an inability to practice in Tennessee temporarily. Missing the application deadline could prevent you from assisting during critical health crises. Ensure all required information and documents are submitted to avoid complications.
- Inability to Practice: Without this application, you cannot legally practice during emergency situations.
- Delayed Medical Response: Your absence may impede timely medical assistance during crises.
- Legal Consequences: Practicing without proper authorization may lead to legal repercussions.
How do I know when to use this form?
- 1. Temporary Work Authorization: For professionals needing temporary practice rights.
- 2. Emergency Medical Support: If you're assisting in public health emergencies.
- 3. Cross-State Medical Assistance: For healthcare providers relocating temporarily for work.
Frequently Asked Question
How do I fill out the application?
Begin by entering your personal information and attaching required documents.
Who qualifies to submit this application?
Any licensed healthcare professional from another state assisting during COVID-19.
Is there a fee for this application?
No, there is no fee associated with submitting this application.
How do I submit the completed application?
Email the completed application to TN.Health@tn.gov with the subject line specified.
What identification do I need to attach?
You need to provide a legible copy of your driver's license or photo identification.
Can I apply if I am not a U.S. citizen?
You must indicate your citizenship status on the application.
What if I have held a license in multiple states?
List all states where you have held a professional license in the application.
How do I keep a copy of my submitted application?
Make sure to save a copy before sending it via email.
Is it necessary to have a license in my home state?
Yes, you need to be a licensed professional in a state to apply.
What happens after I submit my application?
You will receive confirmation of receipt and further instructions based on your application.
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