This is only for initial full licensure...not for renewal of a full license.
Applicants should download or print the Application Kit—it contains all the necessary documents.
Please read the instructions carefully before completing your application.
Application Kit for Initial Full License
- Application Kit for Initial Full License file size 2MB
The application kit is an Adobe PDF (Portable Document Format). You must have the Adobe Acrobat Reader Plugin for your browser in order to download or print the documents. Download the free Adobe Reader, then run the installation program to add the plugin to your browser.
The application documents are also available in Word format. IF YOU CHOOSE NOT TO USE THE KIT, THEN YOU MUST DOWNLOAD OR PRINT ALL THE DOCUMENTS BELOW. ALL FORMS MUST BE SUBMITTED.
- Letter to Applicant
- Full License Application Instructions
- Application Checklist (Form 1)
- Full License Application Form (Form 2)
- Medicare Tax Form (Form 3)
- EHR Proficiency Form (Form 3A) Effective April 1, 2015
- 90 Day Form (Form 4)
- Moral and Professional Form (Form 5)
- Authorization for Release (Form 6)
- CORI Acknowledgment Form (Form 7)
- Full License Supplement (Form 8)
- Medical Education Verification (Form 9)
- Postgraduate Training Verification (Form 10)
- Evaluation Form (Form 11)
- State License Verification (Form 12)
- Malpractice History Form (Form 13)
- Name Change (Form 14)
- Full Form E-1
- Full Form E-2
- Full Equivalency Waiver (Form J)
This information is provided by the Board of Registration in Medicine.