Physician - Special Permits: Locum Tenens

The Locum Tenens license allows the applicant to temporarily maintain the practice of another physician including providing emergency room services normally provided by the other physician. You must hold a valid license to practice medicine and surgery issued by another licensing jurisdiction of the United States or Canada. A Locum Tenens license shall expire 90 days from the date of its issuance.

For cause shown to the satisfaction of the board, the board may renew such temporary license for additional periods of 90 days each, but no such license may be renewed more than 3 consecutive times.

Below are some general instructions for applying for a credential on LicensE. 

1. Create or log into your LicensE account. Please visit LicensE account Information page for detailed guidance on selecting your account type.

2. Select "Apply for a License."

3. Select your Category.

4. Select your License Type.

5. Select your Application Method, then "Next."

6. Review your Personal Information.

7. Enter the requested Information on each page of the application. Information may include Examination, Education, or License History, depending on your profession.

8. If applicable, request a Veterans Fee Waiver or Initial Credential Fee Reduction.

9. Submit the requested Documents you may already have. You do not need to have all documents ready to submit.

   Note: Forms are now hosted on AccessGov. Visit AccessGov Forms Directory to choose your form.

10. Respond to the Attestation questions.

11. Provide Payment Information. Fees may be found Credential Fees.

12. Submit your application.  

Profession specific application requirements can be found in the "Application Information" section.

After logging in, select Apply for a License and choose:

• Category: Health
• License Type: Physician – MD or Physician – DO
• Method: Special Permit
• Select which special permit you are seeking: Locum Tenens

Optional: Enter your FSMB Federation ID information

If you have an account and profile with the FSMB, you may enter the FSMB Federation ID to prepopulate school information, post-graduate training and fellowships, practice history, and other activities. This does not verify these items. We are currently aware of an issue where some FSMB Federation IDs are not being recognized by LicensE. If you receive an error when entering your ID, continue with your application by entering education, training, and other activity information manually into the application.

Optional: Enter your Specialties

We do not verify specialties. This information may be updated in the future on your application and/or license by submitting a LicensE support ticket at LicensE.wi.gov. A support ticket may be submitted by using the Request Support feature at the top of the page.

Please Note: You are not required to provide all documents before initial application submission. You do not need to upload documents to every available category.

Enter your Post-Graduate Training/Fellowships, Practice, and Other Activities information in the application process. In addition to postgraduate training, include all employment, privileges, and other activities for the last 3 years.

Have each facility where you have worked in the last three years complete Form 2167 and send directly to the Department. We cannot accept verification submitted by the applicant.

If a facility is unwilling or unable to complete the form, we will need a statement from the facility as to why they cannot complete the form. Applications without all employment verifications may require additional review.

Have verification of at least one current, active license sent directly to us (not temporary or educational/training license). We can accept verifications directly from other state boards by email (DSPSCredMedBd@wisconsin.gov), postal mail, VeriDoc, or the LicensE third party upload portal.

Questions and clarifications about your application should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

A letter from a physician licensed to practice medicine and surgery in this state requesting the applicant’s services. This must include start and end dates in MM/DD/YYYY).

Have the other physician upload the letter directly to your application documents area through the LicensE third party upload portal at LicensE.wi.gov. They will need your application PAR number for successful upload

Complete Form 1229 - Communicable Diseases Certification if you answered ‘No’ to the application Declaration question regarding state health laws related to communicable diseases. Review the laws DHS Administrative Code (link available below).

Complete Form 12829 - Physician Malpractice Suits or Claims Form and upload all required documents directly to your LicensE application’s Supporting Documents page in the Malpractice Suits or Claims section.

Supporting Documents for State Board Discipline – If a licensing agency has ever taken disciplinary action against you, upload a statement and copies of all disciplinary documents.

The Department accepts the physician information profile completed by FCVS through the Federation of State Medical Boards (FSMB). If you choose to utilize FCVS, you may not need to submit DSPS forms to verify the following: 

• Medical School Education (Form 2164);
• Post-Graduate Training (Form 2165);
• Reporting of licensure exam scores;
• Physician Data Center Profile from the FSMB;
• National Practitioner Data Bank Report;
• ECFMG certificate. 

You may obtain this service online at the FSMB website

Note: The FSMB Uniform Application (UA) does not provide the same items as the FCVS report. See the FSMB website for more information. Staff will upload documents from FSMB when they review your application.

We are not collecting photographs at this time. This will be marked off on your due diligence once your application is reviewed.

After you upload all required documents, submit your application, and pay the required fee(s):

1. Preliminary Application Reference Number (PAR)

   1. Your application will be assigned a Preliminary Application Reference number or PAR number. This number allows you and trusted parties to look up the status of your application without logging in. You can also reference this number in any support tickets you submit in regard to your application.

      • A trusted 3^rd party can look up your credential status by visiting LicensE, clicking “Application Status Lookup” and entering the PAR number you have provided to them.

2. Review Timeline

   1. Your materials will be reviewed within approximately 10 days by a member of the credentialing team.

      • Note: Some licenses do take longer to process due to complexity. You can see the performance data on our LicensE Dashboard to see what date we are reviewing for certain application types under "Application Review Times by Profession."

3. Pending Applicant Input Status

   1. After this review, if anything is missing or the credentialing team has any questions on your application, your application will go back into a status called “Pending Applicant Input.”  You will receive an email letting you know your application was moved into this status. You should then log into LicensE and check your application “Due Diligence.”

4. To check your "Due Diligence" 

   1. Your Due Diligence is a checklist of items required for your credential.

   2. The Due Diligence section is how DSPS staff will communicate with you regarding your credential requirements.

   3. Log in to your LicensE account

   4. Click on "Check Application Status" 

   5. Your credential application should be shown on this page. Under “Action” select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop.

   6. After clicking the upside-down triangle, select “View Due Diligences.”

   7. The Due Diligence column lets you know what the requirement is.

   8. The “STATUS” column will you know if the item is “Met”, “Not Met”, or “Not Applicable.”

      • Items listed as “Not Met” are items that are needed by the Department.  

   9. The “NOTES” column of your Due Diligence will provide further written details or instructions about what is still needed.

5. To upload documents

   1. Some applications require additional document uploads.

   2. Log into your LicensE account

   3. Click on "Check Application Status"

   4. Your credential application should be shown on this page. Under "Action" select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop. 

   5. After clicking the upside-down triangle, select "Upload Document."

   6. The document must be an allowable document type. 

   7. After uploading the document, click "submit." If you do not, it will not be sent to a reviewer. 

6. If you have any questions, you can submit a support ticket on LicensE by logging in and clicking "request support" at the top of the page.

LicensE statuses that require action from applicant:

LicensE statuses that indicate the application is with Department staff:

Support Ticket
Submit a support ticket on LicensE and click "request support." Please provide as much detail as possible regarding your concern so we can work to answer your question with a one touch resolution. 

Call
608-266-2112

Email
dsps@wisconsin.gov

Office Hours
7:45am-4:30pm
Department of Safety and Professional Services
4822 Madison Yards Way
Madison, WI, 53705

Note: The in-person office does not process same day.