Medical Board of California State of California | Business, Consumer Services, and Housing Agency | Department of Consumer Affairs PNS App Info (Rev 07/24)
Medical Board of California
Application for a Physician’s and Surgeon’s
License Information & Checklist
Licensing Program
2005 Evergreen Street, Suite 1200
Sacramento, CA 95815-
5401
Phone: (916) 263-
2382
www.mbc.ca.gov
LICENSE INFORMATION
You must obtain a Physician’s and Surgeon’s (P&S) License from the Medical Board of California (Board) prior
to practicing medicine in California. A licensed physician may diagnose, prescribe, and administer treatment
to individuals suffering from injury or disease. Physicians are authorized to administer and prescribe
medication, use devices to sever or penetrate tissues, and to use all methods in the treatment of diseases,
injuries, deformities, and other physical and mental conditions.
You must submit your P&S License application online using the BreEZe Online Services
. The online
application requires you to provide detailed information. Each page of the online application will time out after
approximately 15 minutes. To help with the completion of the application, review the “Application Preparation”
section to complete each page within the 15-minute time limit, otherwise the system will time out.
To allow sufficient time for processing and remediating deficiencies, the Board strongly encourages you to
submit your Application for a Physician’s and Surgeon’s License six months in advance.
MINIMUM REQUIREMENTS
You must have received all your medical school education from and graduated from a:
1)
U.S. or Canadian medical school accredited by the Liaison Committee for Medical Education (LCME),
the Committee on Accreditation of Canadian Medical Schools, or the Commission on Osteopathic
College Accreditation. http://lcme.org/directory/accredited-u-s-programs/
- OR -
2)
International medical school which has been evaluated by the Educational Commission for Foreign
Medical Graduates (ECFMG) or one of the ECFMG authorized foreign medical school accreditation
agencies and deemed to meet the minimum requirements substantially equivalent to the requirements
of medical schools accredited by the Liaison Committee on Medical Education, the Committee on
Accreditation of Canadian Medical Schools, or the Commission on Osteopathic College Accreditation.
The
international
medical school is listed on the World Federation for Medical Education (WFME) and
the Foundation for Advancement of International Medical Education and Research (FAIMER) World
Directory of Medical Schools joint directory, or the World Directory of Medical Schools.
https://search.wdoms.org/
-
OR -
3)
International
medical school that has been approved by the Board.
http://www.mbc.ca.gov/Applicants/Medical_Schools/Schools_Recognized.aspx
Disclosure of a United States Social Security Number (SSN) or an Individual Taxpayer Identification Number
(ITIN) is mandatory prior to the issuance of a
license. Section 30
of the Business and Professions Code
(BPC)
authorizes collection of an SSN or ITIN. Section 31(e) of the BPC
allows the State Board of
Equalization and the Franchise Tax Board to share taxpayer information with the Board.
To meet the examination requirement,
you
must have taken and passed all steps of the United States
Medical Licensing Examination (USMLE),
or
Part 1 of the Licentiate of the Medical Council of Canada
(LMCC) examination, or other acceptable examinations per Title 16 of the California Code of Regulations
(CCR) section 1328
.
Note
:
An applicant who obtains a passing score on all parts of Step 3 of the USMLE in more than four
attempts must meet the requirements of BPC section
2135 or 2135.5
to be considered eligible for issuance
of a
P&S license pursuant to BPC section 2177(c)(2).
Certification by the
Educational Commission for Foreign Medical Graduates (ECFMG) is required if
you
graduated from an international medical school. To obtain further information regarding ECFMG Certification,
please refer to
the ECFMG website at http://www.ecfmg.org/.
Application Information for a Physician and Surgeon License – Page 2
MINIMUM REQUIREMENTS (Continued)
To meet the postgraduate training requirement for licensure,
you
must have received 12 months credit of
Board
-
approved postgraduate training for graduates of medical schools in the United States and Canada or
24 months credit of
Board-
approved postgraduate training for graduates of international medical schools
approved under
BPC section 2084. Board-
approved postgraduate training must be accredited by the
Accreditation Council for Graduate Medical Education (ACGME) if completed in the United States and its
territories, or the Royal College of Physicians and Surgeons of Canada (RCPSC) and/or The College of
Family Physicians of Canada (CFPC) if completed in Canada.
INITIAL P&S LICENSE RENEWAL REQUIREMENT
As a requirement of the initial license renewal, the licensee must provide verification of receiving credit of 36
months of
Board-approved postgraduate training. This documentation may be provided with the initial licens
e
application or after the issuance of the license and no later than the license expiration date
.
If your training was part of the MD/DDS
-integrated
Oral and Maxillofacial Surgery (OMFS) postgraduate training
program,
then you must provide evidence of receiving credit for at least 24 months of postgraduate training
accredited by the Commission on Dental Accreditation (CODA) to meet the initial renewal requirement. CODA-
accredited postgraduate training must be part of an
oral and maxillofacial surgery postgraduate training program
after receiving a medical degree from a combined dental and medical degree
program.
The current program director or the designated institutional official (DIO) must provide a signed and dated
Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA
-
PTB) or Certificate
of Completion of CODA Postgraduate Training (Form
CODA1-
CODA2), directly to the Board to verify
completion of required training. The Board recommends providing this documentation as soon as the
required training is completed rather than waiting until your license expiration date. This will help avoid any
delay in processing the required documentation
, your P&S license expiring
, and the need to cease all clinical
practice
.
Proof of the required postgraduate training must be mailed to the Board and postmarked no later than
the license expiration date to be considered by the Board. Please note that your license will be
automatically placed in delinquent status pending review if you do not submit proof of the required
postgraduate training
by the license expiration date.
You are
NOT
required to provide this documentation of postgraduate training after the issuance of your P&S
License if you meet either of the following criteria:
•
Provided
, and the Board accepted, verification of successfully receiving credit of 36 months of Board
-
approved
postgraduate training during the initial license
application process (you will be notified by the
Board once this requirement has been met),
- OR -
•
You were
licensed pursuant to BPC sections 2135, 2135.5, 2151, or 2428
, or if you used experience
under a
BPC section 2113 permit to qualify for a P&S license
(you will be notified by the Board once this
requirement has been
met).
GENERAL INFORMATION
As an applicant, you are personally responsible for all information disclosed on the application,
including any responses that may have been completed on your behalf or information provided to
you by others. The
Board may deny your application based upon omission, falsification or
misrepresentation of any item or response on the application or any attachment. The Board considers
violations of an ethical nature to be a serious breach of professional conduct.
Fingerprints:
Applicants who reside in California must complete the electronic Live Scan fingerprint
process. The
Request for Live Scan Service form may be obtained from the Board’s website
. Please refer
to the following website for Live Scan facilities in California:
https://oag.ca.gov/fingerprints/locations.
Applicants residing outside California must submit two completed fingerprint cards or if visiting California,
may have their fingerprints completed electronically at a California Live Scan facility.
The Board must receive Criminal Records Check from both the California Department of Justice and the
Federal Bureau of Investigation prior to the issuance of a Physician’s and Surgeon’s License.
Application Information for a Physician and Surgeon License – Page 3
GENERAL INFORMATION (Continued)
Information Privacy Act
:
The Licensing Program of the Medical Board of California requests this
information to determine your eligibility for a
P&S License.
The Board may reject your application as
incomplete if you fail to provide the requested information
.
The Board will use the information you provide to
verify your identity and determine your qualifications for licensure per sections 2064.5 and 2080 of the
California Business and Professions Code (BPC), which authorizes the collection of this informatio
n.
The Board may transfer the provided information on your application to other medical licensing authorities,
the Federation of State Medical Boards, or other governmental law enforcement agencies.
Custodian Of
Records:
The Licensing Program Chief is the custodian of records. Access to records by the
individual to whom they pertain may be obtained under the Information Practices Act, Civil Code section
1798.17, by contacting the Board.
Grounds for Denial:
The Board reviews e
ach applicant’s credentials for licensure in California on an
individual basis. The Board has the authority to deny licensure based upon an applicant’s act of dishonesty,
unprofessional conduct, conviction of a crime, discipline by a Licensing Board outside of California, or
inability to practice medicine safely. See BPC sections 480, 2221, and 2234 for further information.
Priority Review and Expedited Licensure:
Review the additional requirements on qualifying for
Priority
Review and Expedited Licensure
as outlined below
. The Board will NOT expedite review of your application
nor the licensure process if any of the required documents are missing or
do not meet the requirements:
SkillBridge
Beginning July 1, 2024, the Board shall expedite the initial licensure process for an applicant who is an
active-
duty member of the US Armed Forces and enrolled in the US Department of Defense SkillBridge
program. (BPC section 115.4)
To expedite review of your application, you must attach a copy of the following documentation on the
attachments page of the online application:
•
Proof of enrollment in the US Department of Defense SkillBridge program, such as a letter signed by
your commanding officer.
Honorably Discharged Veterans of the United States Armed Forces
The Board is required to expedite the application review and licensure process if you have served as an
active-duty member of the United States Armed Forces and were honorably discharged (BPC section 115.4)
To expedite the review of your application, you must
attach a copy of the following documentation on the
Attachments page of the online application:
•
O
fficial orders issued by the United States Armed Forces verifying that you
have been, or will be,
honorably discharged.
Practice in Medically Underserved Area or Population
The Board is required to expedite the application review and licensure process if you have received and
accepted an offer of employment to work in an area of California formally designated as an underserved
area or underserved population. (BPC section 2092)
To expedite the review of your application, you must
attach a copy of the following documentation on the
attachments page of the online application:
1)
A signed and dated letter from
you to confirm that you accepted
employment in California to provide medical
services to a formally designated underserved area and/or population.
2)
A signed and dated letter from your prospective employer confirming their offer of prospective
employment to provide medical services to a formally designated underserved area and/or population in
California. The letter must include the proposed employment start date, the name and address of the
facility(s) where you will provide medical services, and the medical specialty of the medical services you
will provide.
Application Information for a Physician and Surgeon License – Page 4
GENERAL INFORMATION (Continued)
Priority Review and Expedited Licensure:
(Continued)
Provide Abortions Within the Scope of Practice of Their Medical License
An applicant who demonstrates they intend to provide abortions within the scope of practice of their license
may qualify for expedited application processing, if they provide the B
oard with the documentation identified
below. An “abortion” is any medical treatment intended to induce the termination of a pregnancy except for
the purpose of producing a live birth.
To expedite the review of your application, you must attach the following documentation with your
application:
•
A letter declaring your intent to provide abortions; and,
•
A letter from an employer or health care entity indicating that you have accepted employment or entered into
a contract to provide abortions. This letter must include:
1)
The starting date;
2)
The location where you will be providing abortions; and,
3)
That you will be providing abortions within the scope of practice of your applicable license, in
accordance with BPC sections 2253, 2725.4, and 3502.4.
Spouse or Domestic Partner of an Active-Duty Member of the United States Armed Forces
The Board is required to expedite the review of your application and licensure process and waive the
application and initial license fee if you are a spouse of, or in a domestic partner
ship or other legal union
with, an active-duty member of
the United States Armed Forces who is assigned to a duty station in
California under official active-duty military orders. (BPC section 115.5)
To expedite the review of your application, you must
attach a copy of the following documentation to your
online application:
E
vidence that you are married to, or in a domestic partnership or other legal union with, an active-
duty
member of the
United States Armed Forces who is
assigned to a duty station in California under official
orders,
Evidence of your domestic partner’s or spouse’s official assignment to a duty station in California, and
Evidence that you h
old a current, active, and unrestricted medical license in another state, district,
or
territory of the United States.
Admitted to the United States as a Refugee, Granted Asylum, or Have a Special Immigrant Visa Status
The Board is required to expedite the review of applications and initial licensure process for certain applicants
described below. (BPC section 135.4) To have your
application expedited, one of the following statements must
apply to you:
•
You were
admitted to the United States as a refugee pursuant to section 1157 of title 8 of the United
States Code; or
•
You were granted asylum by the Secretary of Homeland Security or the United States Attorney General
pursuant to section 1158 of title 8 of the United States Code; or
•
You have
a special immigrant visa and were granted this status pursuant to section 1244 of Public Law 110
-
181, Public Law 109
-163, or section 602(b) of title VI of division F of Public Law 111-
8, relating to Iraqi and
Afghan translators/interpreters or those who worked for or on behalf of the United States government.
To expedite the review of your application, you must attach a copy of one of the following documents
to your
online application:
•
Form I
-94, Arrival/Departure Record, with an admission class code,
such as “RE” (Refugee) or “AY”
(Asylee) or other information designating the person a refugee or asylee.
Special immigrant visa that includes the “SI” or “SQ.”
•
Permanent Resident Card
(Form I-
551), commonly known as a “Green Card,” with a category designation
indicating that the person was admitted as a refugee or asylee.
•
An order from a court of competent jurisdiction or other documentary evidence that provides reasonable
assurance that the applicant qualifies for expedited licensure.
Application Information for a Physician and Surgeon License – Page 5
GENERAL INFORMATION (Continued)
Temporary License
:
The Board may issue a temporary Postgraduate Training License if you are married
to, in a domestic partnership or in other legal union with, an active
-duty member of
the United States Armed
Forces who is assigned to a duty station in California under official active
-duty military orders. (
BPC section
115.6
).
A temporary license is valid for a period of 12 months, allowing
you
to complete the application process for
the full P&S license. Upon issuance of the temporary license,
you will receive a wall certificate and
your
temporary license profile will be available on the Board's License Verification page, once approved.
You must hold a current, active, and unrestricted medical license in another state, district, or territory of the
United States. You must attach a copy of the following documentation to your online application:
•
Evidence that you are married to, or in a domestic partnership or other legal union with, an active-duty
member of the United States Armed Forces who is assigned to a duty station in California under official
orders.
Evidence of your domestic partner’s or spouse’s official assignment to a duty station in California.
•
Evidence you hold a current, active, and unrestricted medical license in another state, district, or territory
of the United States.
For minimum requirements,
information, instructions, and forms, please visit the
Physician and Surgeon
Temporary License page on the Board’s website.
Third Party Services
: You may use electronic services to assist in completing your
application for licensure.
The Board does not mandate any of the
commercial
electronic services. For additional information, visit the
Board’s website. The Board is providing this information as a convenience to its applicants.
Third Party Authorization:
You can authorize an individual to receive information about the status of your
license application from the Medical Board of California (Board) and/or to authorize an individual to submit
documentation on your behalf to the Board as part of the license application by providing the individual’s name
and email address when completing the online licensing application. If you wish to add an authorized individual
after submitting your license application, you can email the name and email address of the individual(s) to
[email protected], from the email address on file with the Board, or to your reviewer. If you
wish to later rescind your authorization of authorized individua(s), you must notify the Board in writing.
Authorized Representative:
You have the option of adding an Authorized Representative to your account after
you register with BreEZe. An authorized representative can perform the following functions for the physician:
make payments, apply for renewals, and maintain license information. To add an Authorized Representative to
your account, the person you want to add must first register with BreEZe and you must know the Authorized
Representative’s BreEZe User ID. You can reference the
Adding an Authorized Representative user guide
for a
step-by-step tutorial.
Application Information for a Physician and Surgeon License – Page 6
GENERAL INFORMATION (Continued)
Application
Preparation:
The online application requires you to provide detailed information. Each page of
the online application will
time out after approximately 15 minutes
. Gather the following information before
starting your online application to avoid your application timing out.
Your full legal name and either your Social Security Number or ITIN.
Address of Record, which the Board uses
to contact you and will become public information once
licensed.
All examinations for licensure you have taken, and date passed (USMLE, LMCC
, FLEX, NBME, or
state medical board).
Medical school(s) name, mailing address, attendance start and end dates, title of degree awarded,
and date degree was awarded.
California ACGME-
accredited postgraduate facility name, anticipated attendance dates, and
specialty.
Previously attended ACGME, RCPSC, or CFPC-
accredited postgraduate training facility name, dates
of attendance, and specialty.
Medical license(s) ever held, issuing U.S. State, Territory, or Canadian Province, including
, but not
limited to, temporary, provisional, or training license(s) regardless of license status.
If applying for priority review and expedited licensure, all documents required to verify you meet the
requirements, as indicated in the “Priority Review and Expedited Licensure” section above.
As indicated below, you may attach some required documents to the
Attachments
screen of your online
application.
Previously Licensed in California:
In accordance with BPC section 2428
, a physician whose California
P&S license expired five or more years ago must reapply for licensure. If you voluntarily canceled your
license, you must reapply regardless of the period.
Although section 2428 allows you to undertake a re
-
application process that is significantly streamlined, you
must meet all the requirements as if you were applying for licensure for the first time. For information on what
is required to requalify for lice
nsure and how to apply, see the Board’s Previously Licensed webpage.
You may
NOT apply online if you have been previously licensed in California;
you must submit a paper
application with the required fees. In addition, you must return your original California wall certificate. If it
has been lost or destroyed, you must submit a notarized statement indicating the reason you are unable to
return the original.
Limited Practice License:
In addition to the application, supporting documents, and fees to obtain a
P&S
L
icense, you must submit the Limited Practice License Form (Form
LPL) to apply for the limited practice
license. The form is located on the
Board’s website and should be submitted with the online
application or
mailed to the Board after you submit
the online application.
Please refer to the Board’s
Limited Practice License webpage
for eligibility information and clinical evaluation
requirements.
Application Information for a Physician and Surgeon License – Page 7
APPLICATION CHECKLIST
Listed below are the minimum application materials and supporting documentation required for a
medical school graduate to obtain a P&S License. This list is not all-inclusive as additional items may
be necessary based on responses provided on the application or information obtained from other
entities.
You are required to submit the following items:
Application, Fees, Fingerprints, Explanations and Timeline of Activities
Application For Physician’s and Surgeon’s License
All items in this application are mandatory. If you are unable to submit an online application, email
with the reasons you are unable to apply online and the Board will
determine the next steps.
When submitting your application online using the BreEZe Online Services, each page of the online
application will time out after approximately 15 minutes. To help with the completion of the application,
review the “Application Preparation” section of this document to complete each page within the 15-minute
time limit, otherwise the system will time out.
Your P&S License will be issued using your full legal name including middle name or initial and/or suffix.
Onc
e your license is issued, you may apply for a Fictitious Name Permit if you choose to practice medicine
in California using another name. If you have used multiple variations of your name in the past, you may
attach a copy of a current government issued photographic identification (e.g., driver’s license, immigration
registration card, passport, etc.) with your application so the review process is not delayed.
If you have changed your name legally in the past, attach a copy of legal documents as proof of name
change (e.g., Certified Court Order, Marriage Certificate, Dissolution of Marriage (Divorce), etc.).
Application Fee - $674.00
You must pay the
required application fee for the Board to review your application. The Board will
determine the application received date based on the receipt of both the application and the application
fee.
The application fee includes the required $49.00 fingerprint-processing fee. The fees are non-refundable.
The application fee of $625 may be waived if you are applying as a spouse of, or in a domestic partnership
or other legal union with, an active-duty member of the United States military. However, you will still be
required to pay the $49 fingerprint-proces
sing fee. To qualify for the fee waiver, you must submit the
required supporting documents listed under “Priority Review and Expedited Licensure.”
Initial License Fee or Reduced Initial License Fee
The initial license fee is $1,176.00, which includes the $25 Steven M. Thompson fee. Applicants may be
eligible for the reduced license fee of $600.50, which includes the $25 Steven M. Thompson fee, if enrolled
in a Board-
approved postgraduate training program and upon completion of the Current Postgraduate
Training Verification, Form CTV.
The initial license fee of $1,151 or the reduced initial license fee of $575.50 may be waived if you are
applying as a spouse of, or in a domestic partnership or other legal union with, an active-duty member of
the United States military. You will be required to pay the $25 fee for the Steven M. Thompson Physician
Corps Loan Repayment Program. To qualify for the fee waiver, you must submit the required supporting
documents.
When applying online through BreEZe, you will be required to pay all required fees, including the initial
li
cense fee.
Application Information for a Physician and Surgeon License – Page 8
APPLICATION CHECKLIST (Continued)
Application, Fees, Fingerprints, Explanations and Timeline of Activities
(Continued)
SONG-BROWN FAMILY PHYSICIAN TRAINING ACT (Voluntary Fee - $25.00 Minimum)
You may voluntarily contribute a minimum of $25.00 to the Song-Brown Health Care Workforce Training
Act (Song-Brown Program). The Board transfers all funds collected monthly to the Department of Health
Care Access and Information
(HCAI), formally known as the Office of Statewide Health Planning and
Development (OSHPD). The Song-
Brown Program was established to increase the number of family
physicians to provide needed medical services to the people of California. For further information regarding
the program, please visit the HCAI website at:
https://hcai.ca.gov/loans-scholarships-grants/grants/song-brown/.
Fingerprints: Live Scan Form (CA Only) - OR - Two (2) Fingerprint Cards
If you reside in California, you must complete the electronic Live Scan fingerprint process. You will need
to download and use the Request for Live Scan Service from the Board’s website. You may upload a
copy of the completed form with your application.
If you reside outside of California, you must submit two completed fingerprint cards or have your
elec
tronic fingerprints completed at a California Live Scan facility. The Board will mail you your
fingerprint cards once the Board receives your application and the required fees. You must complete all
personal data on the fingerprint cards, or the Board will return the cards to you for completion.
The Board must receive the Criminal Records Check from both the California Department of Justice and
the Federal Bureau of Investigation prior to the issuance of a P&S license.
Explanation For Application Question, Form EXP (If applicable)
You may use this form to provide a detailed written explanation for a “Yes” response to a question on the
Board’s application. A separate Form EXP is required for each question.
You must attach the written explanation in BreEZe when submitting your application. Once you submit
your online application in BreEZe, you cannot go back and submit additional documents to the Board
through BreEZe.
Timeline of Activities, Form TOA
Provide the Board with a written chronological description of all professional and non-professional
activities, from the date of graduation, with no gap greater than 3 months.
If you have completed any externships, observerships, or volunteer activities in California, please include
a detailed description of the duties and responsibilities along with the location and name of the supervising
physician.
You must attach the signed and dated Timeline of Activities form to the Attachments screen of your online
application. Once you submit your online application in BreEZe, you cannot go back and submit additional
documents to the Board through BreEZe.
Application Information for a Physician and Surgeon License – Page 9
PRIMARY SOURCE DOCUMENTS
You must contact the appropriate entity to request they submit the documents below directly to the Board.
The Board will NOT accept the following documents if they are submitted by the applicant.
Examination Documentation
ECFMG Certification Status Report: (International Medical School Graduates Only)
A Certification Status Report from the ECFMG is required to verify the certification is valid. To obtain
further information, visit the ECFMG website at www.ecfmg.org. The Board will only accept an
electronic submission of the Certification Status Report directly from ECFMG or if primary source
verified in the Federation Credentials Verification Service (FCVS) profile.
Official Examination Scores from the appropriate examination entity:
USMLE, Federation of Licensing Examiners (FLEX), National Board of Medical Examiners (NBME),
Licentiate of the Medical Council of Canada (LMCC) and State Board Exams
Each examination agency must submit an official examination history report directly to the Board
to be acceptable or if primary source verified in the Federation Credentials Verification Service
(FCVS) profile. You must request the examination history from the appropriate examination agency’s
websites listed below:
USMLE/FLEX/SPEX – www.fsmb.org/transcripts
(The Board will only accept electronic submission of the
Transcript of Scores.)
NBME - w
ww.nbme.org
LMCC - www.mcc.ca (The Board will only accept electronic submission of the Statement of Registration.)
Note: If you obtain a passing score on all parts of Step 3 of the USMLE in more than four
attempts, you must meet the requirements of BPC section 2135 or 2135.5 to be considered
eligible for issuance of a P&S license pursuant to BPC section 2177(c)(2).
Medical Education Documentation
Certificate of Medical Education, Form MED
A Certificate of Medical Education (Form MED) is required from each medical school attended. Complete
the applicant information at the top of the form and send it to the medical school. A medical school official
must complete, sign and date Form MED. Any fields or questions left unanswered will require completion
of a new form.
A "Yes" response to any of the Unusual Circumstance questions on Form MED requires a signed and
dated letter of explanation, on medical school letterhead, from the current medical school official.
The medical school must submit the completed form and letter of explanation directly to the
Board through the Board’s Direct Online Certification Submission (DOCS) portal.
Official Medical School Transcript
An official medical school transcript and translation (if not in English) is required from each medical school
attended. The Transcript must be prepared on the university letterhead affixed with the signature of the
dean or registrar and the medical school seal, documenting all the basic science and clinical courses
completed during the medical curriculum.
A transcript uploaded to the DOCS portal does not require a medical school seal.
The medical school must submit the transcript directly to the Board through the Board’s DOCS
portal, or a Board accepted Third Party Service.
Application Information for a Physician and Surgeon License – Page 10
PRIMARY SOURCE DOCUMENTS (Continued)
You must contact the appropriate entity to request they submit the documents below directly to the Board.
The Board will NOT accept the following documents if they are submitted by the applicant.
Medical Education Documentation (Continued)
Certified Copy of Medical School Diploma
For international medical school graduates only, a certified copy of the medical school diploma and
translation (if not in English) is required. The certified copy must have the original signature of the dean or
registrar of the medical school affixed with the official medical school seal and include a statement attesting
that the copy is a true and correct copy of the original.
A diploma uploaded to the DOCS portal does not require a medical school seal.
The medical school must submit the certified copy of the diploma directly to the Board through the
Board’s DOCS portal or a Board accepted Third Party Service to be acceptable.
Certified English Translations (if applicable)
Certified English translations are required for all academic documents that are not prepared in the English
language. Refer to the Translation of International Academic Credentials information sheet on the Board’s
website for details regarding acceptable English translations.
The translator/agency m
ust mail the official certified translation with a copy of the original
language document directly to the Board or the medical school must submit the certified
translation through the Board’s DOCS portal to be acceptable.
Postgraduate Training Documentation
Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training, Form PTA-PTB
A Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA-PTB) is required to
verify participation in all ACGME, RCPSC, or CFPC-accredited postgraduate training
programs attended,
regardless of whether you completed the program or received partial credit or no credit.
To meet the minimum requirements, the program director or the designated institutional official (DIO) must
submit Form PTA-PTB to verify the receipt of 12 months credit of Board-approved postgraduate training for
graduates of medical schools in the United States and Canada or 24 months credit of Board-approved
postgraduate training for graduates of international medical schools. You must submit a form to each
postgraduate training program attended for completion. Each program must submit a PTA-PTB form to verify
years of training if you completed training in more than one program.
The current program director or the DIO must provide all required information and responses on the form and
sign and date the form.
A program seal or notary is not required when submitted through DOCS.
A "Yes" response to any of the Unusual Circumstances question(s) on Form PTA requires a signed and dated
letter of explanation, on facility letterhead, from the current program director or the DIO.
The program must submit the completed form and/or letter of explanation directly to the Board
through the Board’s DOCS portal
if the applicant has an open application with the Board.
Application Information for a Physician and Surgeon License – Page 11
PRIMARY SOURCE DOCUMENTS (Continued)
You must contact the appropriate entity to request they submit the documents below directly to the Board.
The Board will NOT accept the following documents if they are submitted by the applicant.
Postgraduate Training Documentation (Continued)
Certificate of Completion of CODA Postgraduate Training, Form CODA1-CODA2 (if applicable)
A Certificate of Completion of CODA Postgraduate Training, Form CODA1-CODA2 is required to verify
completion of 24 months of postgraduate training accredited by the Commission on Dental Accreditation
(CODA) only if the training was completed prior to obtaining a P&S License.
If 24 months of CODA-accredited training is not completed prior to issuance of your P&S License, then it
must be completed as part of the initial license renewal process.
The current program director or DIO must provide all required information and responses on the form and
sign and date the form.
A program seal or notary is not required when submitted through DOCS.
A "Yes" response to any of the Unusual Circumstances question(s) on Form CODA1 requires a signed
and dated letter of explanation, on facility letterhead, from the current program director or the DIO.
The program must submit the completed form and/or letter of explanation directly to the Board
through the Board’s DOCS portal
if the applicant has an open application with the Board.
Current Postgraduate Training Verification, Form CTV (if applicable)
If you are currently enrolled in an ACGME, RCPSC, CFPC, or CODA-accredited postgraduate training
program when paying the initial licensing fee, the Current Postgraduate Training Verification (Form CTV)
is necessary to be eligible for the reduced initial license fee.
The current program director or the DIO must provide all required information and responses on the form
and sign and date the form.
The program must submit the completed form directly to the Board through the Board’s DOCS
portal if the applicant has an open application with the Board.
