Get Fl Dr-416 2025-2026

This guide provides comprehensive instructions for filling out the Florida DR-416 form, known as the physician's certification of total and permanent disability. We will walk you through each section, ensuring a clear understanding of the requirements and steps involved.

Follow the steps to complete the FL DR-416 form with ease.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the first section, enter the physician's name. This field requires the full name of the licensed physician completing the certification. Ensure that the name is written clearly and correctly.
3. Next, you must provide the name of the person who is totally and permanently disabled. You will see options for Mr., Mrs., Miss, or Ms., select the appropriate title before entering their full name.
4. Enter the social security number of the person with a disability. This information is mandatory for verifying identity and must be entered correctly without any omissions.
5. Indicate the date when the individual was determined to be totally and permanently disabled. Enter this date in the specified field.
6. Select the applicable mental or physical condition causing the disability. Options include quadriplegia, paraplegia, hemiplegia, legal blindness, or other total and permanent disabilities. If the patient does not require a wheelchair for mobility, check the designated box.
7. Continue by affirming the physician's belief regarding the individual's disability. This statement must reflect that all given information is true and accurate to the physician’s knowledge.
8. The physician should then provide their signature, date the form, and fill in their address. This includes the street, city, state, and zip code.
9. Lastly, enter the Florida Board of Medicine or Osteopathic Medicine license number and the date it was issued. Ensure this information is accurate to avoid complications.
10. Once you have filled out all required fields, save your changes. You may also choose to download, print, or share the completed form as needed.

Complete the FL DR-416 and other documents online to ensure a smooth and efficient process.