Licensees employed or seeking employment with a health care facility, licensed by the Agency for Health Care Administration (AHCA), who have been found guilty, regardless of adjudication, or entered a plea of guilty or nolo contendre to any of the criminal offenses listed in Sections 435.03(2), 435.04(2), and 408.809, Florida Statutes, must apply for an exemption through the Department of Health.

Upon receipt, board staff will review the application and documentation to ensure that all required information has been received. Staff will review the disqualifying offenses to determine if board action is required. If so, you will receive a formal meeting notice once the application has been placed on the next available meeting agenda. For board meeting dates and locations, please visit our Meetings page.

To obtain the exemption application form and instructions, please visit AHCA’s website.

AHCA’s Exemption from Disqualification page

Exemption applications should be mailed directly to the Board of Physical Therapy Practice. Applications mailed to AHCA will not be processed or forwarded to the board. Mail your completed application and supporting documents to:

Board of Physical Therapy Practice 
4052 Bald Cypress Way 
BIN C-05 
Tallahassee, FL 32399-3255

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