MAKING APPLICATION FOR A LICENSE TO
PRACTICE MEDICINE IN NORTH DAKOTA

Forms of Licensure

Application Form Instructions
Please read before downloading forms.

Application Forms

Interviews

CME Requirements

Helpful Hints

Forms of Licensure

This Board has the authority to issue the following forms of licensure:

  1. Permanent Licensure

  2. Provisional Temporary Licensure. A provisional temporary license may be granted to an applicant who has met all requirements for licensure except that he/she has not yet appeared for an interview. A provisional temporary license is only valid until the time of the next regular meeting of the Board of Medical Examiners. No applicant may be granted more than one provisional temporary license.
  3. Locum Tenens Permit. Locum tenens permits are issued for a specific practice site and only for a period not exceeding three (3) months.

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Application Form Instructions

The application cannot be submitted online.
 The application form (hard copy) must be returned to the Board's office along with the following documents:
1. $247.25 application and criminal background check fees (payable by check or money order only in U.S. currency). Includes application fee of $200 and criminal background check fee of $47.25).
2. Photocopy of diploma from medical school (if applicable, an English translation must be included).
3. Photocopy(s) of all internship/residency/fellowship certificates.
4. Photocopy(s) of American Board certificate(s) and/or Canadian Board certificate(s).
5. Notarized photocopy of marriage certificate or legal name change document if your name differs from that on any of your documents.
6. Two recent unmounted photographs of yourself - one should be affixed to Page 6 of the application. The photographs must be of original passport quality, no larger than 2" x 3" and no smaller than 2" x 2" and should be a close-up front view of head and shoulders taken no longer than 90-120 days prior to filing this application.
7. Photocopy of ECFMG certificate (Required of graduates of international medical schools except those schools located in Canada, England, Scotland, Ireland, Australia, and New Zealand). You must also request an ECFMG status report to be sent directly from the ECFMG to our Board. The two forms required to be submitted to the ECFMG are indicated on our web site under "Application Forms". (Also see item #4 of the application).
8. The "Certificate of Medical Education" form must be completed by your medical school and must be sent directly from your medical school to the North Dakota State Board of Medical Examiners by mail or fax (701/328-6505).
9. You must direct the licensing board of every state/province where you have ever applied for any type of medical license (regardless of whether the license was granted or not granted, is active or inactive, temporary or permanent, restricted or unrestricted) to provide the North Dakota Board of Medical Examiners with verification of your licensure status.
10. You must request the appropriate organization to send an original transcript of your licensing exam scores to the North Dakota State Board of Medical Examiners (See item #6 of the application for further details).
11.

You must submit a completed Authorization for Criminal Record Inquiry form which is available on this website under “Application Forms”, and two fingerprint cards.

Fingerprint cards are available at local law enforcement offices. You should call your local law enforcement office for times and locations that fingerprinting services are available. Please be sure to bring a photo ID. A small fee ($5-$10) may be required.

DO NOT BEND OR FOLD the fingerprinting cards when mailing them to us as they will be rejected and you will be required to be fingerprinted again.

NOTE: WE WILL NOT BEGIN PROCESSING THE APPLICATION UNTIL THE PERSONAL AUTHORIZATION FOR CRIMINAL RECORD INQUIRY AND FINGERPRINTING CARDS (2) ARE RECEIVED.
12. Your application and supporting documents should be mailed to:

NORTH DAKOTA STATE BOARD OF MEDICAL EXAMINERS
CITY CENTER PLAZA 
418 EAST BROADWAY AVE., SUITE 12 
BISMARCK, ND 58501


Notes
1.

Documents, which are required to be notarized, must include a statement from a notary public attesting to the fact that the photocopy is a true copy of the original documents.

2.

The North Dakota State Board of Medical Examiners does accept the Physician Information Profile produced by the Federation of State Medical Boards Credentials Verification Service (FCVS). You may contact the FCVS toll-free at 1-888-275-3287 if you choose to do so. You are not required to subscribe to the FCVS.

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Application Forms

The standard North Dakota medical licensure application form is used for each type of licensure.

Application Form

Certificate of Medical Education Form

ECFMG 1 (Form 282A-SB)
Form for Requesting Status Reports of ECFMG Certification for State Medical Boards

ECFMG 2 (Form 900)
Payment Form for State Medical Boards

Authorization for Criminal Record Inquiry

NOTE: To view and use these documents, Adobe Acrobat Reader 4.0 must be installed on your computer.
 If you do not have Adobe Acrobat Reader 4.0, download and install it free of charge.


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Interviews

All applicants seeking permanent licensure in this state must appear before the Board of Medical Examiners for an interview EXCEPT FOR THOSE APPLICANTS WHO MEET EACH OF THE REQUIREMENTS IN ONE OF THE FOLLOWING GROUPS:

GROUP 1

  1. The applicant has graduated from an approved medical school in the United States or Canada, AND;
  2. No derogatory information was brought to the attention of the Board of Medical Examiners during the application process.

-OR-

GROUP 2

  1. The applicant has graduated from a medical school that was listed in the World Health Organization Directory of Medical Schools at the time of the applicant's graduation, AND;
  2. No derogatory information was brought to the attention of the Board of Medical Examiners during the application process.

Any applicant may be required to appear for an interview at the Board's discretion.

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CME Requirements

The 1997 legislative assembly enacted a statute directing the Board of Medical Examiners to develop a set of administrative rules, which would establish mandatory continuing medical education requirements for North Dakota physicians.

To view the full text of the CME rules click here.

A brief summary of the essential points embraced by these rules is as follows:
Question How many CME hours will be required each year?
Answer An average of 20 hours.
Question How often must a licensee report his/her CME credits?
Answer Every third year.
Question Which credits will be accepted?
Answer

AMA Category 1 Credit, AOA Category 1 Credit, AAFP Prescribed Credit, certain Canadian courses, and "other courses approved by the North Dakota State Board of Medical Examiners as being equivalent to AMA or AOA Category 1 Credit".
Question What process will be used to verify compliance?
Answer Each physician will be provided with a form in certain designated years. That form will be mailed with the physician's license renewal packet and will require the physician to declare that he/she 1) has complied with the CME requirements; 2) has not complied with the CME requirements, or; 3) is exempt from meeting those requirements. The Board will follow up on the information supplied by the physicians with a series of random audits.

It is important to understand that even though the Board will not require every physician to itemize detailed information about individual CME courses on each reporting form, every physician must keep a careful record of his/her CME activities. Detailed information will be required when the physician is audited.

Question How will these requirements be enforced?
Answer The statute being implemented by these rules provides that "Before a license may be renewed, the licensee must submit evidence [of compliance] to the Board...". A physician who must declare that he/she has failed to comply with the CME requirements will not be relicensed for the upcoming year. Obviously, it will not always be possible to complete a random audit before a license must be renewed. Consequently, if a physician declares he/she has met the requirements and the application for renewal of licensure is otherwise valid on its face, then the Board will renew the license, however, if the Board subsequently completes an audit and finds that the physician cannot demonstrate compliance with the rule, then a disciplinary action will be brought against that physician for making a false statement on the renewal form.
Question When will the first reports of compliance be required?
Answer Those physicians whose surnames begin with letter A-H will first report their CME credits to the Board when they renew their license for the year 2001. Those physicians whose surnames begin with the letter I-O will first report their CME credits to the Board when they renew their license for the year 2002. Those physicians whose surnames begin with letter P-Z will first report their CME credits to the Board when they renew their license for the year 2003. In each case the physician will be required to report the CME credits earned during the three-year period ending at the time of their report.
Question Who is exempt?
Answer

The following physicians are not required to meet the North Dakota Board of Medical Examiners' CME requirements:

  1. Physicians who are enrolled in full-time graduate medical education programs (residencies and fellowships) which are accredited by the Accreditation Council on Graduate Medical Education or the American Osteopathic Association.
  2. Physicians who hold a locum tenens permit or a special license and those physicians who have not renewed their licenses for the first time since being granted a regular permanent license by the Board.
  3. Physicians who have retired from the active practice of medicine. This exception is available only to those retired physicians who have completely and totally withdrawn from the practice of medicine. Any physician seeking to be excused from completing CME requirements under this subsection must submit an affidavit to the Board of Medical Examiners (on the Board's form) certifying that the physician will render no medical services during the term of the next CME reporting period. These physicians are only eligible for a Special Emeritus License (SEL), not a regular license. A SEL does not authorize the licensee to engage in the practice of medicine. The SEL is an honorary type of license that is issued free of charge. The SEL is "valid" for the lifetime of the physician to whom it has been issued.

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Helpful Hints

SAVE TIME! SAVE MONEY! REDUCE ANXIETY!

The North Dakota State Board of Medical Examiners annually processes hundreds of applications for licensure. In each case, the Board conducts a thorough evaluation of medical credentials, employment or work history, malpractice history, and disciplinary history. This process takes time - anywhere from a few weeks to several months, depending in large part upon how quickly the applicant complies with what is requested of his/her and the nature of any problems requiring closer scrutiny. In spite of the fact that there is no guarantee of licensure, some applicants make commitments to start work at a certain time and later find that the commitment cannot be kept. Please remember that the Board will not accelerate one application at the expense of another, nor will it forego any elements of its screening process. The following suggestions are offered to help those who apply for licensure, as well as those who recruit physicians:

  1. Give the Board enough time to do its job. For something as important as a medical license, two months lead-time is not unreasonable.
  2. Don't make commitments on loans, practice start dates, home purchases, etc., until a license is granted. Not all physicians who apply will receive a license. Don't set yourself or your colleagues up for disappointment or financial setbacks based on mere speculation.
  3. Make sure all application materials are sent to the Board as quickly as possible, in accordance with the directions set forth in the application packet. Deadlines are strictly enforced. Don't waste valuable time assuming that an exception will be made or that a requirement will be waived for you.
  4. If there are items on the application about which the Board desires additional information, or if there is any derogatory information that comes to light, it may take the application longer to get through the review process.
  5. Remember that regardless of the date of issuance, all licensees whose surnames begin with letters A-L expire on December 31st of each year, and all licensees whose surnames begin with letters M-Z expire on June 30th of each year.
  6. The North Dakota State Board of Medical Examiners does accept the Physician Information Profile produced by the Federation of State Medical Boards Credentials Verification Service (FCVS). You may contact the FCVS toll-free at 1-888-275-3287 if you choose to do so. You are not required to subscribe to the FCVS.

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© 1997 by The North Dakota State Board of Medical Examiners
All Rights Reserved.
Last modified on Thursday, December 8, 2005