Frequently Asked Questions

The physician/surgeon performing surgical procedures and recovery room personnel must be certified in ACLS by an approved provider. See Rules 64B8-9.009(4)(b)4. and 64B8-9.009(6)(b)4., F.A.C., for more information.

At least one staff person assisting the physician/surgeon during surgery must be certified in BLS by an approved provider. See Rules 64B8-9.009(4)(b)2.b. and 64B8-9.009(6)(b)1.b., F.A.C., for more information.

A pediatric patient is a child of 13 years of age or younger. Certification in Pediatric Advanced Life Support is required when treating pediatric patients. See Rule 64B8-9.009(1)(e), F.A.C., for more information.

A physician/surgeon must have documented staff privileges at a licensed hospital within reasonable proximity (30 minutes) to perform the same procedure in that hospital as that being performed in the office setting, must be able to document satisfactory completion of training such as Board certification or Board eligibility by a Board approved by the American Board of Medical Specialties or any other board approved by the Board of Medicine, or must be able to demonstrate comparable background, training, and experience. In addition, the physician/surgeon must have knowledge of the principles of general anesthesia.

Every Florida licensed physician who holds an active Florida license and performs Level II or Level III office surgery, as fully defined in Rule 64B8-9.009, F.A.C., must register with the Board of Medicine. It is the physician’s responsibility to ensure that every office in which he or she performs Levels II or III surgical procedures as described above is registered, regardless of whether other physicians are practicing in the same office or whether the office is non-physician owned. The new physician/surgeon must submit a signed office surgery registration form and all required documentation. The physician/surgeon must immediately notify the Board office, in writing, of any changes to the registration information. Office Surgery Registration Application.

A physician/surgeon cannot provide anesthesia when performing Level II or Level III procedures. In such cases, anesthesia must be provided by a qualified anesthesia provider. Licensed health care personnel, such as a physician/anesthesiologist, certified registered nurse anesthetist, physician assistant, anesthesiologist assistant under the direct supervision of an anesthesiologist, or registered nurse qualified by training in anesthesiology, may assist the physician/surgeon. See Rules 64B8-9.009(4)(b)4. and 64B8-9.009(6)(b)4., F.A.C., for more information.

A physician/surgeon cannot administer anesthesia and perform the surgical procedure. A qualified anesthesia provider is required to administer the anesthesia and cannot perform any other function in the procedure room. See Rule 64B8-9.009(4), F.A.C., for more information.

The crash cart must include, at a minimum, the following resuscitative medications:

• Adenosine 6 mg/2 ml x 3
• Albuterol Inhaler
• Amiodarone 150 mg x 2
• Atropine 0.4 mg/ml; 3 ml
• Calcium chloride 10%; 10 ml
• Dextrose 50%; 50 ml
• Diphenhydramine 50 mg
• Dopamine 200 mg minimum
• Epinephrine 1:10,000 dilution; 10 ml
• Epinephrine 1:1000 dilution; 1 ml x 3
• Flumazenil 0.1 mg/ml; 5 ml x 2
• Furosemide 40 mg
• Hydrocortisone or Methylprednisolone or Dexamethasone
• Lidocaine 100 mg
• Magnesium sulfate 1 gm x 2
• Naloxone 0.4 mg/ml; 3 ml
• Propranolol 1 mg x 1
• Sodium bicarbonate 50 mEq/50 ml
• Paralytic agent that is appropriate for use in rapid sequence intubation
• A calcium channel blocker class drug
• Intralipid 20% 500 ml solution (only if non-neuraxial regional blocks are performed)

See Rule 64B8-9.009(4)(b), F.A.C., for more information.

Level II office surgeries require the following equipment:

• Full and current crash cart at the location the anesthetizing is being carried out
• A benzodiazepine must be stocked, but not on the crash cart
• Suction devices, endotracheal tubes, laryngoscopes, etc.
• Positive pressure ventilation device plus an oxygen supply
• Double tourniquet for the Bier block procedure
• Monitors for blood pressure/EKG/oxygen saturation
• Emergency intubation equipment
• Adequate lighting
• Emergency power source able to produce adequate power to run required equipment for a minimum of two hours
• Appropriate sterilization equipment
• IV solution and IV equipment

See Rules 64B8-9.009(2) and 64B8-9.009(4)(b)3., F.A.C., for more information.

Applicable statutes and rules do not specify standard dimensions for the physical plant of an office surgery facility. It is suggested that you contact your local city and county clerk’s office for specific rules and code descriptions and restrictions.

A physician/surgeon must be assisted by a qualified anesthesia provider, or a registered nurse may assist with the anesthesia if the physician/surgeon is ACLS certified. An assisting anesthesia provider cannot function in any other capacity during the procedure. If additional assistance is required due to the specific procedure or patient circumstances, it must be provided by a physician, osteopathic physician, registered nurse, licensed practical nurse, or operating room technician. See Rule 64B8-9.009(4), F.A.C., for more information.

Licensed health care providers are required to monitor the recovery of a patient who has been given anesthesia. A physician, osteopathic physician, physician assistant, or registered nurse with an ACLS certification (for Level II procedures) and post-anesthesia training and experience (for Level III procedures) must be available. See Rule 64B8-9.009(4)(b)4., F.A.C., for Level II office surgeries and see Rule 64B8-9.009(6)(b)4., F.A.C., for Level III office surgeries.