Jay Feldman Application PackageFeldman Jay S
Last Name First Name Middle Initial
3765 Sheridan Avenue Miami Beach
Home Address City
FL 33140
State Zip Code
2482526740
HomeWork
jay.feldman@gmail.com
Email Address
2482526740
Cellular
Business Address City State Zip Code
Occupation:Business Name:
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note
that only three (3) choices will be observed by the City Clerk’s Office. (Regular Boards of City)
Choice 1:
Choice 2:
Choice 3:
Health Advisory Committee
BOARD AND COMMITTEE
APPLICATION FORM
Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below
questions:
Have you ever resided in one of the City's Historic Districts for at least one year?Yes
No Address in City Historic District submitted.
Professional License
License Number Issuance Date Expire Date
Medical Doctor ME 128421 1/25/2022 1/31/2024
Note:If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of
your currently effective corresponding professional license.
Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be
affiliated with the city. This requirement shall be fulfilled in the following ways:
NoResident of the City for a minimum of six (6) months:
Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:Yes
AFFILIATION WITH THE CITY OF MIAMI BEACH
a.
● I am resident of:Middle Beach
Or
b.
"Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10%
or more of the outstanding capital stock) in a business.
"Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
c.Full-time employee of such a business (for a minimum of six months); and I am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months):No
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be
approved by a 4/7th vote of the Mayor and City Commission.
NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the
City affiliation requirements of section 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit,
stipulating that they have met either (or both) of said affiliation requirements. The original affidavit shall be filled
with the Office of the City Clerk prior to being sworn in as a member.
Or
No● Have you ever been convicted of a felony:If yes, please explain in detail:
● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail:
● Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail:
● Are you currently serving on any City Boards or Committees:No If yes, which board?
● Are you presently a registered lobbyist with the City of Miami Beach?No
● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
Emergency Medicine Physician with 10+ years of practice in diverse contexts including large volume, high-acuity
hospitals, rural medical practices, mass gathering events, local urgent care offices, and concierge delivery.
Proven executive leadership experience in the private healthcare sector: startup business development, quality
control, and medical supervision. Training and institutional consultation related to operations, compliance, and
standards of care.
It would be an honor and a privilege to be a member of the Miami Beach Health Advisory Committee. Thank you
for considering my application.
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY
BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office
(Miami Beach Code section 2-26)
o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law
regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic
right of access to most meetings of Boards, Commissions, and other governing bodies of state and local
governmental agencies or authorities.
o Voting conflict - Form 8B is for use by any person serving at the county, city, or other local level of government on
an appointed or elected Board, Council, Commission, Authority, or Committee. It applies equality to members of
advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143.
Florida Statutes.
● In what organization(s) in the City of Miami Beach do you currently hold membership in?
Name Position
Hatzalah South Florida Vice Chair of Medical Direction
● List the address of all properties owned or in which you have an interest within the City of Miami Beach:
Property
3765 Sheridan Avenue, Miami Beach, FL 33021
If so, which department and title?No● Are you now employed by the City of Miami Beach:
● Pursuant to City Code Section 2-25 (b):
Do you have a parent, spouse, child, brother, or sister who is employed by the City of Miami Beach?No
If "Yes", identify person(s) and department(s):
No relative's information submitted.
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with
Miami-Dade County Financial Disclosure Code Section 2-11.1(i)(2)
I understand that no later than July 1, of each year all members of Boards and Committees of the City of Miami
Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial
Disclosure Requirements.
One of the following forms must be filled with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "Source of Income Statement;" or
2. A "Statement of Financial Interests (Form 1)¹ ;" or
3. A Copy of your latest Federal Income Tax Return.
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine of no
more than $500, 60 days in jail, or both.
_____________________________
¹ Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant
to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County Supervisor of
Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 with the
County Supervisor of Elections automatically satisfy the County’s financial disclosure requirement as a Miami Beach
City Board/Committee member and need not file an additional form with the Office of the City Clerk. However,
compliance with the County disclosure requirement does not satisfy the State requirement.
DIVERSITY STATISTICS REPORT
The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to
comply with City diversity reporting requirements.
WhiteRace/Ethnic Categories
What is your race?
No details providedOther Description:
Gender:Male
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No
Physically Challenged:No
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND
THAT THE FACTS STATED IN IT ARE TRUE. ADDITIONALLY, I AGREE AND ACKNOWLEDGE THAT ANY
FALSE STATEMENTS OR FALSE INFORMATION SUBMITTED AS PART OF THIS APPLICATION SHALL BE A
BASIS FOR MY REMOVAL FROM A CITY BOARD OR COMMITTEE. I HAVE RECEIVED, READ, AND WILL
ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED “STANDARDS OF
CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS” AND ALL OTHER APPLICABLE
CITY, COUNTY, AND/OR STATE LAWS AND STATUTES ACCORDINGLY.
I Jay Feldman agreed to the following terms on 11/7/2023 2:43:22 PM
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
Board and Committee Application Checklist: Please ensure you have provided all information before applying or
reapplying to any Board and Committee.
YES
YES
YES
YES
I have answered all questions fully.
I have uploaded a current resume, photograph, and a copy of any applicable professional license.
I have completed and attached the Board & Committee Financial Acknowledgment Statement.
I have completed and attached the Diversity Statistics Report.
If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or
telephone: 305.673.7411
Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as
public records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you
do not wish your home address, telephone numbers, and/or photograph to be made public, please:
1) Use your office or other address for your mailing address;
2) Use your office or other telephone number for your contact number; and
3) Do not attach a photograph.
Jay S Feldman,MD
4045 Sheridan Avenue,po box 113,Miami Beach FL 33140 |jay.feldman@gmail.com |248.252.6740
PROFESSIONAL SUMMARY
Emergency Medicine Physician with 10+years of practice in diverse contexts including large volume,high-acuity
hospitals,rural medical practices,mass gathering events,local urgent care o
LEADERSHIP &COMMITTEE SERVICE
Hatzalah South Florida Emergency Rescue/Ambulance Service 01/23 –present
Vice Chair of Medical Direction
Professional development curriculum,continuous medical education implementation,medical protocol
guidelines creation,weekly case report review,monthly QA/QI meetings,and multidisciplinary resuscitation
simulations.Hatzalah is the largest volunteer medical group in the United States.Our South Florida division
has 250+state-certi
SpineWellnessAmerica
Interventional Pain Rotation Observer &Participant 08/19 –03/20
Waterbury Hospital
Emergency Department Assistant Medical Director 03/16 –07/16
St John’s Riverside
Faculty Ultrasound Curriculum Interim Director 09/13 –06/15
Resuscitation Bay Redevelopment Project Manager 11/13 –06/15
University of Nevada School of Medicine
AAEM/RSA Vice Presidential Council Resident Representative 09/12 –06/13
Emergency Preparedness Committee Resident Representative 09/12 –06/13
Interdepartmental Wellness Committee Chair 07/12 –06/13
Emergency Medicine Wellness Committee Chair 07/10 –06/13
Quality Improvement &Patient Safety Committee Resident Representative 07/10 –06/13
Resident Forum Resident Representative 07/10 –06/13
ACGME CLER visit Resident Representative 08/2012
“Burning Man”Festival Physician 08/2012
“Electric Daisy”Carnival Physician 07/2012
“Code Silver”Mass Casualty Simulation Coordinator 05/2011
Sackler School of Medicine
Student Council Class President 09/07 –06/10
Student Council Class Vice President 09/06 –06/07
“The Synapse”(University Journal)Senior Editor 09/07 –06/10
Consultant,Broward County Mass Casualty Incident.Broward Sim Center,FL 08/17 –Present
Collaborated with Aventura &Kendall EM,Anesthesia,and General Surgery Faculty,
Davie Fire &Rescue,Davie College of Nursing and the Broward Health Sciences
Simulation Center to develop large scale mass casualty incidents designed to stress
the operations systems of county rescue operations and in-hospital patient care.
Educator,IMPACTS Pediatric Code Simulation.Saint John’s Riverside Hospital 08/13 &11/13
Lead clinician in pediatric resuscitation simulation.
Founder,Operations Elective.University Medical Center,Las Vegas,NV.07/12 –06/13
Developed curriculum for residents interested in pursuing the business of
emergency medicine,operations planning,metrics monitoring,ED throughput,etc.
Instructor,JTM Tactical Medicine Training Group.Nellis Air Force Base,NV.07/11 –06/13
Instructor to US Special Forces and civilian pre-hospital personnel for EMT,critical
care and PHTLS curriculum,Evaluator/Grader for practical medical training scenarios.
3
Participant,“Every Fifteen Minutes.”Legacy High School,Las Vegas,NV.08/2012
Public Television documentary on teenage drunk driving.
Scenario Director,Emergency Medical System for Children.Caliente,NV.01/2011
Directed pediatric resuscitation &developed mock code scenarios physicians,nurses
and EMT’s in a Nevada desert rural hospital.
Instructor,Lake Mead EMS Refresher.Lake Mead,NV.12/2010
Provided lecture and assisted in skills lab for EMT-B’s,Paramedic and Fire
Bledsoe,Bryan E.,Casey,Michael J.,Feldman Jay.,Johnson,Larry.,Diel,Scott.,Forred,Wes.,Gorman,Codee.
"Glasgow Coma Scale Scoring Is Often Inaccurate."Prehospital and Disaster Medicine Prehosp.Disaster Med.
30.01 (2014):46-53.
“Angioedema &the Approach to the Complicated Airway.”Lecture at the Emergency Department University
Medical Center,August 2012.
“Hypertensive Emergency:Taking the Pressure O
CERTIFICATION &LICENSURES
American Board of Emergency Medicine Current
Medical License:Florida State Physician
Tactical Combat Casualty Care Instructor
PreHospital Trauma Life Support Instructor
Advanced Cardiac Life Support Provider
Advanced Trauma Life Support Provider
Advanced Hazmat Life Support Provider
Pediatric Advanced Life Support Provider
Outdoor Emergency Care Technician –National Ski Patrol Provider (former)
Emergency Medical Technician –Intermediate Provider (former)
Wilderness First Responder Provider (former)
PROFESSIONAL SOCIETY MEMBERSHIPS
American College of Emergency Physicians (ACEP)2010 –2022
American Academy of Emergency Medicine (AAEM)2010 –2022
American Medical Association (AMA)2019 –2021
American Society of Regional Anesthesia and Pain Medicine (ASR A)2019 –2020
American Society of Interventional Pain Physicians (ASIPP)2019 –2020
American Society of Pain and Neuroscience (ASPN)2019 –2020
REFERENCES
Dennis Yi Tenen,PhD
CEO,Health Shield Logistics,Miami FL
dt2406@columbia.edu
William Jaquis,MD
Immediate Past President,American College of Emergency Physicians;Senior Vice President,Envision Health
william.jaquis@emcare.com
Randy Katz,DO
Executive District Manager,Emergency Medicine Services,Memorial Healthcare System
randy_katz@teamhealth.com
Michael Corvini,MD
President,Southeast Region,Team Health,Ashville TN
corvini.michael@gmail.com
Additional references &information available upon request
6