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Medical Office Forms in Pdf - DOC


Medical Office Forms in Pdf document sample

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									                       Suggested N.C. License Application Timeline

USMLE Step 3
Cost: $655
Suggested deadline: September 1 prior to your matriculation year
        The absolute latest you should take Step 3 is within the first several months of your
        third/final year of residency. You ideally should have Step 3 scores in-hand prior to
        submitting your FCVS application.

North Carolina Medical Board (“For Physicians” tab > “Licensing” on left column)
Cost: $388
Suggested deadline: January 31 of your matriculation year

You have two options when applying for your full NC license. You can do it using the
Full License Application Not Using FCVS or using the Full License Application Using
FCVS. Using FCVS is an extra step that is detailed below that will add time and money
to your application process now but may save you both in the future.

       Allow 4 to 6 months for the NCMB to process your application by July 1. This is
       definitely the rate-determining step of the application process. If you submit when
       they get into the highest-volume portion of the season, your application will be
       slowed markedly. Remember that the NRMP residency match is in March of the
       medical student’s matriculation year – so the NCMB will be loaded with training
       license applications starting in late March.

       For NCMB, you will need to have:
       • Two residency program people fill out a form attesting that you’re a nice person
       • A letter from someone who has known you for at least 10 years, excluding a parent
       • 2 Fingerprint cards using cards that the NC State Bureau of Investigation will send
       to you upon request – these can be done through local police or state attorneys
       general’s offices (for a fee). $15 at the UNC Public Safety office. They have
       fingerprint cards in their office. Instructions for filling out the cards found at ublic/Physicians/MD_Forms.pdf

       If there are any eccentricities in your file, you may be asked to appear before the
       NCMB for an interview – but this rarely happens. The Board meets at least once a
       month (although rumor has it that they meet twice a month during the heaviest
       portion of the season).

       Check on the status of your application periodically. They’ll tell you that email is the
       best option, but be firm about following up phone calls or emails with additional
       messages if 48 hours pass and you haven’t heard anything. Even though their
       website and materials state otherwise, the NCMB will not tell you about missing
       items in a proactive way. It’s important for you to be somewhat aggressive about
       following up on things.


 American Medical Association Physician Profile
Cost: $30
Suggested deadline: December 31 prior to your matriculation year
The NCMB requires you to have an AMA P hysician Profile, so you have to create one
concurrent with your NCMB application. The AMA will send the profile directly to the NC
Medical Board, usually in only a few short business days.

 National Practitioner Data Bank/Healthcare Integrity and Protection Data Bank
Cost: $16
The self-query must be notarized and then sent back to the Data Bank. The data bank will
then send you your self-query results, which you will then need to send to the NC Medical

 USMLE Transcripts – FSMB website
Cost: $50
The FSMB will send your USMLE transcripts to the NC Medical Board, usually in a few
short business days.

The following forms can be found at the NCMB website: ublic/Physicians/MD_Forms.pdf

   Medical School Certification Form – must attach a picture and send it to your
      medical school dean’s office for signature and seal placement. The form should
      then be directly sent to the NC Medical Board.

   Applicant’s Oath – which must be notarized (Notary – Glenda Williams in the
      Financial Aid office in the ACC Internal Medicine clinic and someone in the
      GME office)

   Postgraduate Training Verification Form – should be filled out by Dr. Berkowitz
       or somebody from our residency office and sent directly to NC Medical Board.
       (Alternatively, this form will be sent to FCVS if you use their services. Please see
       below for information regarding FCVS.)
Federation Credentials Verification Service (FCVS)
Cost: $295 + $75 per subsequent dispersal
Using FCVS in your application process is OPTIONAL. It adds time to your application
and will cost you more money now but may save you time and money in the future as
you apply for licenses in other states later on.
        FCVS serves as a central repository for your medical licensing and credentialing
        documents – you send them different items and they verify their authenticity. The
        service the n provides a packet containing certified copies of all of these items for
        licensing or credentialing agencies. FCVS then sends this packet to the NC Medical
        Board. The advantage to using FCVS is that in lieu of collecting each of these every
        time you apply for a position or license, you just ask FCVS to send them for you (for
        a small fee).
        Suggested deadline: October 1 prior to your matriculation year. Allow yourself 1 to 2
        months to collect all your paperwork, and 3 to 4 months for FCVS to complete and
        certify your documents. It’s okay to work on this over time, submitting items
        piecemeal as they become available – you don’t have to get everything to them in one
        fell swoop. Do yourself a favor, though, and check on the status periodically.
        The FCVS website is not intuitive to use, and contacting real-person assistance at
        their Texas offices is possible, but very hit-or-miss.
        Items you will need for submission to FCVS:
        • An original copy of your birth certificate. You can obtain one directly from the
        Office of Vital Records from your state of birth, for a fee. This copy will not be
        returned to you.
        • Verification of your attendance at your medical school, via a notarized form sent to
        your medical school’s registrar or student services office and forwarded directly to
        • A copy of your medical school dean’s letter, sent directly to FCVS from your
        medical school.
        • A complete medical school transcript, sent directly to FCVS from the university’s
        registrar’s office.
        • A certified/notarized copy of your medical school diploma.
        • Notarized verification of your post-graduate training, sent directly from your
        residency program office to FCVS.

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