A licensee who has ever held a full license in Massachusetts that was not renewed must complete a lapsed application to revive their license.
Please read the instructions carefully before completing your application.
Remember: If your license lapses, YOU MAY NOT PRACTICE MEDICINE IN MASSACHUSETTS IN ANY FASHION OR CAPACITY UNTIL YOUR LICENSE IS REVIVED BY THE BOARD.
Applicants should download the Lapsed License Application Kit—it contains all the necessary documents.
Lapsed License Application Kit file size 1MB
The application kit is a PDF file (Adobe Portable Document Format). You must have the Adobe Acrobat Reader Plugin for your browser in order to download and use these forms. Acrobat Reader is a free download from Adobe. It can be obtained by clicking on this link. First download the reader, then run the installation program to add the plugin to your browser.
Lapsed License Application Documents
- Lapsed License Letter
- Lapsed License Instructions
- Lapsed License Checklist (Form 1)
- Lapsed License Application (Form 2)
- Lapsed License Supplement (Form 3)
- Medicare Tax Form (Form 4)
- Authorization for Release (Form 5)
- Malpractice History Form (Form 6)
- Evaluation Form (Form 7)
- EHR Proficiency Form (Form 8) Effective April 1, 2015
This information is provided by the Board of Registration in Medicine.
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