"We hereby agree to submit to arbitration under Sections 766.201-.212, Florida Statutes, and Chapter 60Q-3, Florida Administrative Code, the determination of the amount of damages arising from the following medical incident: (Describe the medical incident briefly, specifying dates and the categories of damages sought).
We further agree that the determination of the amount of damages be submitted to a three-member panel constituted or reconstituted in accordance with Sections 766.201-.212, Florida Statutes, and Chapter 60Q-3, Florida Administrative Code.
We further agree that we will faithfully observe this agreement, that we will abide by and fulfill any award rendered by an arbitration panel, and that a judgment of a court having jurisdiction may be entered on the award, provided only that the liability of any insurer shall be subject to applicable insurance policy limits."
Fla. Admin. Code Ann. R. 60Q-3.005
Specific Authority 766.207(9), (10) FS. Law Implemented 766.201-.212 FS.
New 9-6-88, Formerly 22I-7.005, Amended 6-27-00.